Why the study?
What is the incidence of left ventricular thrombus by CMR in STEMI patients treated with primary PCI, and how do outcomes compare between those treated with triple therapy versus dual antiplatelet therapy?
What is the incidence of left ventricular thrombus by CMR in STEMI patients treated with primary PCI, and how do outcomes compare between those treated with triple therapy versus dual antiplatelet therapy?
The incidence of LV thrombus detected by CMR remains high (~20%) in anterior STEMI with depressed LVEF, and treating these patients with triple therapy increases bleeding risk without a clear reduction in embolic complications compared to DAPT in patients without thrombus.
May warrant caution with triple therapy post-STEMI LV thrombus due to bleeding; leaves optimal regimen open for RCTs.
In the primary PCI era, CMR detection of an LV thrombus post-STEMI remains high with incidence of nearly 20% in anterior STEMI with depressed LVEF. Patients with LV thrombus treated by triple therapy had similar embolic complications but higher bleeding complications than those with no LV thrombus treated with dual antiplatelet therapy. A 3 month follow-up CMR scan to guide anticoagulation duration might help mitigate bleeding risk.
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Bulluck et al. (2018) studied this question.
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