Key result
Anterior STEMI was a major risk factor for left ventricular thrombosis after primary PCI (OR 11.93; 95% CI 6.25-22.78; p=0.0003), with an overall LVT incidence of 4%.
Why the study?
Left ventricular thrombosis is a common complication of acute STEMI, motivating a synthesis of evidence on its incidence and risk factors after primary PCI.
What is the incidence and what are the risk factors for left ventricular thrombus in acute STEMI patients treated with primary PCI?
Meta-Analysis
What is the incidence and what are the risk factors for left ventricular thrombus in acute STEMI patients treated with primary PCI?
Odds Ratio: 11.93 (95% CI 6.25–22.78)
p-value: p=0.0003
The incidence of left ventricular thrombus after acute STEMI treated with primary PCI remains clinically significant at 4% overall and 10% for anterior STEMI, highlighting the need for vigilance in high-risk patients.
Synthesizes observational data on LVT incidence and risk factors post-STEMI PCI; leaves open optimal prevention strategies pending randomized trials.
OBJECTIVE: Left ventricular thrombosis (LVT) is a common complication of acute ST-segment elevation myocardial infarction (STEMI). This study attempted to synthesize the available evidence to understand the incidence and risk factors of LVT in acute STEMI patients undergoing primary percutaneous coronary intervention (PCI). METHODS: We searched PubMed, Embase, Cochrane Library, and Web of Science for studies published from January 2001 to January 2022. The random-effects and fixed-effects model meta-analysis estimated pooled incidence, mean difference (MD), odds ratio (OR), and 95% confidence interval (CI). The Review Manager 5.4 software was used for meta-analysis performance. RESULTS: The results of meta-analysis showed that the incidence of LVT in acute STEMI treated by primary PCI was 4% (95% CI [0.03, 0.05]), and the overall pooled incidence in patients with anterior STEMI was 10.0% (95% CI [0.07, 0.12]). Anterior STEMI (OR = 11.93, 95% CI [6.25, 22.78], p = 0.0003), left anterior descending-related infarct (OR = 6.85, 95% CI [3.70, 12.66], p < 0.00001), left ventricular wall motion abnormalities (OR = 7.53, 95% CI [3.18, 17.82], p < 0.00001), and lower post-PCI LVEF (MD = 13.78, 95% CI [12.15, 15.41], p < 0.00001) were risk factors for post-PCI LVT. CONCLUSION: The incidence of LVT after acute STEMI in the PCI era remains high. This study provides a preliminary overview of STEMI patients at risk for post-PCI LVT and will help the design of prospective randomized controlled trials for the management and prevention of LVT.
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Wang et al. (2022) conducted a meta-analysis in Acute ST-segment elevation myocardial infarction (STEMI). Anterior STEMI was evaluated on Left ventricular thrombosis (LVT) (OR 11.93, 95% CI 6.25-22.78, p=0.0003). Anterior STEMI was a major risk factor for left ventricular thrombosis after primary PCI (OR 11.93; 95% CI 6.25-22.78; p=0.0003), with an overall LVT incidence of 4%.
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