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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Left ventricular thrombus after ST segment elevation myocardial infarction: a single-centre observational study
Chathura Ratnayake1, Benjamin Liu2, Jocelyne Benatar3
1Junior Doctor, Green Lane Cardiovascular Services, Auckland City Hospital, Auckland.
Insights
Left ventricular thrombus after ST-elevation myocardial infarction (STEMI) is uncommon but linked to high mortality. Further research into novel oral anticoagulants is recommended.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Modern reperfusion therapies have decreased left ventricular (LV) thrombus incidence post-ST-elevation myocardial infarction (STEMI).
- Limited contemporary data exists on LV thrombus incidence and outcomes in the era of rapid reperfusion.
Purpose of the Study:
- To investigate the incidence and outcomes of LV thrombus in STEMI patients.
- To assess the contemporary occurrence and clinical impact of LV thrombus.
Main Methods:
- Retrospective review of 997 STEMI patients admitted to Auckland City Hospital (2014-2015).
- Data sourced from the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry.
- Analysis included LV thrombus presence, characteristics, treatment, and outcomes.
Main Results:
- LV thrombus was found in 5% (53/997) of STEMI patients, predominantly with anterior STEMI (87%).
- Median LV ejection fraction was 38%; 83% received oral anticoagulation.
- 12-month mortality was 13%, with bleeding in 11%.
Conclusions:
- LV thrombus incidence post-STEMI is low, associated with low stroke rates but high mortality.
- Randomized trials are needed to evaluate novel oral anticoagulants (NOACs) for LV thrombus management.
Aims:
The incidence of left ventricular (LV) thrombus following ST segment elevation myocardial infarction (STEMI) has reduced with modern reperfusion therapies. There is scant local data on the incidence and outcomes of LV thrombus in the contemporary era of rapid reperfusion.
Methods:
Patients with STEMI admitted to Auckland City Hospital between January 2014 and December 2015 were identified using the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry and their clinical notes were retrospectively reviewed.
Results:
Among the 997 patients admitted with STEMI, 53 patients (5%) had LV thrombus. Most patients with LV thrombus had an anterior STEMI (87%). The median time from admission to echocardiography was 48 hours (range 6-552 hours); the median LV ejection fraction was 38% (range 15-53%). Oral anticoagulation was initiated in 44 (83%) patients. LV thrombus resolved in 81% by six months in 42 patients given warfarin. Total mortality at 12 months was 13%. Bleeding occurred in 11% and was the most common treatment-related morbidity.
Conclusions:
The incidence of LV thrombus following STEMI was low and it was associated with a low rate of stroke and systemic embolism but high mortality. Randomised studies are needed to evaluate the efficacy of NOAC's in this context.
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