Left ventricular mural thrombus occurred in 23.5% of patients after anterior ST-elevation AMI and was not associated with increased mortality compared to those without LVMT (11.1% vs 12.8%; P=0.79).
Cohort (n=153)
What is the frequency, predictors, and impact on mortality of left ventricular mural thrombus after anterior STEMI in the era of aggressive reperfusion therapy?
Despite modern reperfusion therapy, left ventricular mural thrombus remains a frequent complication of anterior STEMI, predicted by apical wall motion, but does not increase intermediate-term mortality when treated with warfarin.
Absolute Event Rate: 11.1% vs 12.8%
p-value: p=0.79
BACKGROUND: Left ventricular mural thrombus (LVMT) is a well-known complication of anterior ST-elevation acute myocardial infraction (AMI). It remains unknown how modern therapies have impacted on its occurrence. OBJECTIVES: To define the frequency of LVMT among contemporary patients with anterior ST-elevation AMI, the clinical and echocardiographic predictors of LVMT formation, and the intermediate-term outcomes of patients with LVMT. METHODS: We retrospectively analysed patients (in the years 1997-2002) with a diagnosis of anterior ST-elevation AMI and no prior AMI, and who underwent a thorough echocardiographic assessment within 72 h of admission. Stepwise logistic regression analysis was used to define predictors of LVMT formation. Survival was calculated by the Kaplan-Meier product-limit method. RESULTS: Of the 153 patients with complete data, LVMT was detected in 36 (23.5%). There were no significant differences in baseline demographic and clinical variables between LVMT and non-LVMT patients, or in treatments (all patients received reperfusion treatment). The mean wall motion score index was higher in LVMT than non-LVMT patients (0.88+/-1.79 versus 0.65+/-0.36, respectively; P=0.01), indicating worse cardiac systolic function. LVMT patients were treated with warfarin for 3-6 months. The incidence of death was similar between the groups (11.1% for LVMT patients versus 12.8% for non-LVMT patients, P=0.79) over a mean follow-up of 71-72 months. The only independent predictor found for LVMT occurrence was worse regional wall motion of the apex (odds ratio, 2.04, 95% confidence interval, 1.39-3.03; P<0.001). CONCLUSIONS: In the contemporary 'real-world scenario', despite aggressive reperfusion treatment and anti-aggregant use, the incidence of LVMT remained high after anterior ST-elevation AMI. LVMT was not related to increased intermediate-term mortality when patients were treated with warfarin, and the only predictor of LVMT occurrence was regional function of the apex.
Porter et al. (Wed,) conducted a cohort in anterior ST-elevation acute myocardial infarction (n=153). Left ventricular mural thrombus vs. No left ventricular mural thrombus was evaluated on death (p=0.79). Left ventricular mural thrombus occurred in 23.5% of patients after anterior ST-elevation AMI and was not associated with increased mortality compared to those without LVMT (11.1% vs 12.8%; P=0.79).