Left ventricular thrombi after STEMI in the primary PCI era: A systematic review and meta-analysis

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Research

Background:

• Left ventricular (LV) thrombus formation post-myocardial infarction (MI) is not well-characterized with modern primary percutaneous coronary intervention (pPCI) strategies.
• Lack of current incidence data hinders assessment of prophylactic anticoagulation efficacy.
• This study aims to estimate LV thrombus rates in STEMI patients treated with pPCI.

Purpose of the Study:

• To estimate the incidence of left ventricular (LV) thrombus formation in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI).
• To provide updated data on LV thrombus rates to inform clinical management and future research on anticoagulation therapy.

Main Methods:

• Systematic review and meta-analysis of studies published between 1990 and 2015.
• Searched Ovid MEDLINE and EMBASE databases for relevant literature.
• Included 19 studies with 10,076 patients, focusing on echocardiographically-diagnosed LV thrombi within 90 days of pPCI for STEMI.

Main Results:

• The overall rate of LV thrombi after STEMI treated with pPCI was 2.7% (95% CI 1.9%-3.5%).
• The rate of LV thrombi was significantly higher after anterior STEMI, at 9.1% (95% CI 6.6%-11.6%).
• An inverse relationship was observed between study size and LV thrombus rate in anterior STEMI cases.

Conclusions:

• Left ventricular (LV) thrombi remain a significant clinical consideration in the management of STEMI patients undergoing pPCI.
• The higher incidence of LV thrombi in anterior STEMI underscores the importance of targeted risk stratification and management.
• Further research is critical to estimate thrombus formation and embolization risks and to evaluate the utility of treatment strategies.