A simple clinical risk score (LAD culprit vessel and NT-pro-BNP >236 ng/l) strongly predicted late left ventricular thrombus formation at 4 months (AUC 0.89; 95% CI 0.86-0.91; p<0.001).
Cohort (n=609)
Does a simple clinical risk score predict late left ventricular thrombus formation in patients after STEMI?
A simple clinical risk score using LAD culprit lesion and NT-proBNP > 236 ng/L accurately predicts late left ventricular thrombus formation after STEMI, potentially guiding the selective use of follow-up CMR.
Effect estimate: AUC 0.89 (95% CI 0.86-0.91)
p-value: p=<0.001
Background: Little is known about the prevalence of late left ventricular thrombus (LVT) formation after ST-elevation myocardial infarction (STEMI). Compared with transthoracic echocardiography (TTE), cardiovascular magnetic resonance (CMR) imaging has a much higher sensitivity for LVT detection in patients after acute STEMI. However, routine CMR imaging is currently not integrated in post-STEMI management. We sought to develop a practical risk score for the prediction of late LVT formation after STEMI. Methods and Results: Six hundred and nine patients with STEMI underwent CMR at 3 IQR:2-4 days and 4.4 IQR:4.1-4.9 months after primary percutaneous coronary intervention (PCI) for acute STEMI. A LVT was visualized in 37 patients (6.1 %) at baseline CMR and was newly diagnosed in 10 patients (1.6 %) at 4 months follow-up (4FU) CMR and in 4 patients (0.7 %, 60 % false-negative rate of TTE in detecting LVT) by 4FU TTE. A simple clinical risk score including associates of late LVT (left anterior descending artery as culprit vessel and 4FU NT-pro-BNP > 236 ng/l), with a range of 0 to 2 points (median risk score: 1 point) showed a strong and significantly higher area under the curve (0.89, 95 %CI 0.86-0.91; p < 0.001) for LVT prediction at 4FU than each individual risk factor alone (p < 0.001). The sensitivity and specificity of the risk score were 100 % and 77 %, respectively. Conclusions: The proposed risk score may offer preliminary utility in predicting late LVT and could help to identify patients with STEMI in whom CMR for late LVT assessment might be particularly informative. Additional investigation in larger cohorts is warranted to validate the clinical application of the score.
Holzknecht et al. (Sat,) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=609). Clinical risk score (LAD culprit vessel and NT-pro-BNP > 236 ng/l) vs. Individual risk factors alone was evaluated on Prediction of late left ventricular thrombus (LVT) formation at 4 months follow-up (AUC 0.89, 95% CI 0.86-0.91, p=<0.001). A simple clinical risk score (LAD culprit vessel and NT-pro-BNP >236 ng/l) strongly predicted late left ventricular thrombus formation at 4 months (AUC 0.89; 95% CI 0.86-0.91; p<0.001).