Association Between Gensini Score and Left Ventricular Thrombus in Patients With Acute ST-Segment Elevation Myocardial Infarction

Background:Left ventricular thrombus (LVT) is a serious complication of acute ST-segment elevation myocardial infarction (STEMI). Early risk stratification remains challenging. The Gensini score, quantifying coronary artery disease burden from angiography, may offer early prognostic value.Methods:This retrospective cohort study included 144 patients with a first STEMI treated by primary percutaneous coronary intervention. Patients were stratified into LVT (n = 36) and non-LVT (n = 108) groups based on transthoracic echocardiography. Clinical, laboratory, echocardiographic, and angiographic data were analyzed. The Gensini score was calculated, and multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed.Results:Patients with LVT had a significantly higher median Gensini score (101.0 vs. 46.0, p < 0.001), alongside elevated B-type natriuretic peptide (BNP), reduced left ventricular ejection fraction (LVEF), and a higher incidence of left ventricular aneurysm. In multivariable analysis, a higher Gensini score (adjusted odds ratio [OR]: 1.47 per 10-unit increase, 95% CI: 1.21–2.62, p = 0.015), elevated BNP (OR: 1.32 per 100 pg/mL increase, 95% CI: 1.19–2.05, p = 0.040), reduced LVEF (OR: 0.52 per 5% increase, 95% CI: 0.30–0.84, p = 0.010), and presence of left ventricular aneurysm (OR: 2.46, 95% CI: 1.28–4.67, p = 0.006) were independently associated with LVT formation. ROC analysis identified an optimal Gensini score cut-off of 72.5 (AUC 0.785) for identifying LVT risk.Conclusion:The angiographic Gensini score is independently associated with LVT formation post-STEMI. Readily available after primary PCI, it enhances early risk stratification, potentially guiding intensified surveillance and preventive strategies for high-risk patients.