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Updated: Jan 27, 2026
Primary Outcome Assessment in a Pig Model of Acute Myocardial Infarction
Published on: October 14, 2016
Left Ventricular Thrombus After Primary PCI for ST-Elevation Myocardial Infarction: 1-Year Clinical Outcomes
Alastair J Moss1, Anoop S V Shah1, Eunice T Zuling2
1British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Insights
Left ventricular thrombus is found in less than 3% of ST-elevation myocardial infarction (STEMI) patients treated with primary angioplasty. This study found no increased risk of systemic thromboembolism in STEMI patients with left ventricular thrombus.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Left ventricular thrombus (LVT) is a known complication of acute myocardial infarction (AMI).
- The incidence and risk of systemic thromboembolism in ST-elevation myocardial infarction (STEMI) patients undergoing primary angioplasty remain unclear.
- Contemporary data on LVT in the era of mechanical reperfusion is needed.
Purpose of the Study:
- To determine the clinical outcomes at 1 year for patients with STEMI treated with primary angioplasty who develop LVT.
- To assess the incidence of LVT in STEMI patients treated with primary angioplasty.
- To evaluate the association between LVT and systemic thromboembolism.
Main Methods:
- A cohort of STEMI patients treated with primary angioplasty and undergoing transthoracic echocardiography was recruited.
- The primary endpoint was a composite of all-cause mortality, stroke, and systemic thromboembolism at 1 year.
- Logistic regression was used to compare outcomes between patients with and without LVT, adjusting for key clinical variables.
Main Results:
- Left ventricular thrombus was detected in 2.4% of STEMI patients (40 out of 2608) who underwent primary angioplasty.
- Patients with LVT had a higher incidence of atrial fibrillation post-infarction (15% vs 5.4%).
- The primary endpoint occurred in 10% of patients with LVT and 9.1% of those without LVT at 1 year (HR 0.79, 95% CI 0.23-2.70).
Conclusions:
- Echocardiographic detection of left ventricular thrombus occurs in less than 3% of STEMI patients treated with primary angioplasty.
- The presence of left ventricular thrombus was not associated with an increased risk of systemic thromboembolism in this cohort.
- Further research may explore the specific management strategies for LVT in STEMI patients.
Background:
Left ventricular thrombus formation is a complication of acute myocardial infarction. However, the incidence and risk of systemic thromboembolism in the era of primary angioplasty for ST elevation myocardial infarction (STEMI) is unclear. This study aims to determine clinical outcomes in patients with STEMI treated with primary angioplasty and left ventricular thrombus at 1 year.
Methods:
Patients who underwent primary angioplasty for STEMI and had a transthoracic echocardiogram were recruited. The primary endpoint was a composite of all-cause mortality, stroke, and systemic thromboembolism at 1 year. For the primary endpoint, the difference between the presence and absence of left ventricular thrombus was compared using a logistic regression, adjusting for minimization variables including age, diabetes mellitus, hypertension, and previous stroke.
Results:
Of 2608 patients who underwent primary angioplasty for STEMI, 1645 (63%) patients had a transthoracic echocardiogram performed during the index hospital admission. Forty patients (2.4%) had evidence of left ventricular thrombus on transthoracic echocardiography. Patients with left ventricular thrombus were more likely to develop atrial fibrillation in the immediate postinfarction period (6 [15%] vs 87 [5.4%], P = 0.025). At 1 year, the primary endpoint occurred in 4 (10%) patients with left ventricular thrombus and 146 (9.1%) who did not (logistic regression hazard ratio 0.79, 95% confidence interval 0.23-2.70).
Conclusions:
In the contemporary era of mechanical reperfusion for STEMI, echocardiographic detection of left ventricular thrombus was observed in <3% patients. The presence of left ventricular thrombus was not associated with an increased risk of systemic thromboembolism.
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