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Left ventricular thrombus after ST segment elevation myocardial infarction: a single-centre observational study.

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Left ventricular thrombus after ST-elevation myocardial infarction (STEMI) is uncommon but linked to high mortality. Further research into novel oral anticoagulants is recommended.

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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.