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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
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Incidence of Left Ventricular Thrombus in Patients With Acute ST-Segment Elevation Myocardial Infarction Treated with

Tiffany F Mao1, Ata Bajwa1, Preetham Muskula1

  • 1Department of Cardiovascular Diseases, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.

The American Journal of Cardiology
|November 13, 2017
PubMed

Insights

Left ventricular thrombus incidence after ST-elevation myocardial infarction (STEMI) is lower than previously thought, with only 1.6% of patients affected. Ultrasound contrast agents improve diagnostic accuracy for left ventricular thrombus detection.

Area of Science:

  • Cardiology
  • Medical Imaging

Background:

  • Previous studies reported higher left ventricular (LV) thrombus incidence post-ST-elevation myocardial infarction (STEMI) using 2D echocardiography without contrast.
  • Ultrasound contrast agents (UCAs) enhance diagnostic accuracy for LV thrombus detection.

Purpose of the Study:

  • To determine the early incidence and clinical correlates of LV thrombus in a large STEMI cohort.
  • To assess the impact of UCAs on LV thrombus diagnosis in STEMI patients.

Main Methods:

  • A consecutive cohort of 1,698 STEMI patients undergoing percutaneous coronary intervention (PCI) and early echocardiography were analyzed.
  • Echocardiography, utilizing UCAs in 76% of cases, was performed on hospital day 2.
  • Multivariable logistic regression identified independent predictors of LV thrombus.

Main Results:

  • LV thrombus was identified in 28 patients (1.6%), a significantly lower incidence than previously reported.
  • Left anterior descending intervention (OR 7.58, p=0.001) was independently associated with LV thrombus.
  • Higher LVEF (OR 0.96, p<0.001) and Thrombolysis In Myocardial Infarction III flow (OR 0.41, p=0.060) were associated with reduced LV thrombus incidence.

Conclusions:

  • The early incidence of LV thrombus in STEMI patients is low (1.6%) when using contrast-enhanced echocardiography.
  • UCAs improve the accuracy of LV thrombus detection and exclusion in STEMI.
  • Intervention in the left anterior descending artery and lower LVEF are associated with increased risk of LV thrombus.

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