[Related factors of left ventricular thrombus formation within two weeks in patients with acute ST-segment elevation...

Objective: To investigate the related factors of left ventricular thrombus (LVT) formation within two weeks in patients with acute ST-segment elevation myocardial infarction (STEMI) and left ventricular aneurysm (LVA). Methods: Consecutive inpatients with acute STEMI and left ventricular aneurysm, hospitalized from January 2014 to June 2020 in the First Affiliated Hospital of Zhengzhou University, were enrolled in this retrospective study. Patients were divided into LVT group and non-LVT group according to the presence or absence of LVT. The clinical data, echocardiography findings, coronary angiography and treatments were compared between the two groups. Subgroup analysis was performed on the patients receiving primary percutaneous coronary intervention (PCI). Onset to door, door to balloon, onset to balloon time were also compared. Multivariate logistic regression was used to analyze the related factors of LVT formation early post STEMI in enrolled patients. The effects of each index in multivariate logistic regression analysis were illustrated in the forest plot. Results: A total of 144 patients were included, there were 52 cases (36.1%) in LVT group, the age was (56.4±11.2) years, and 46 (88.5%) cases were male. There were 92 cases (63.9%) in non-LVT group, the age was (61.7±11.5) years, and there were 73 (79.3%) males in this group. The patients in LVT group were younger than those in non-LVT group, the proportion of anemia, history of heavy drinking, history of chronic kidney disease, left ventricular ejection fraction (LVEF) ≤40%, preoperative thrombosis in myocardial infarction (TIMI) blood flow grade 0 and postoperative TIMI blood flow grade ≤2 were significantly higher in LVT group than those in non-LVT group (all P<0.05). The incidence of history of angina, collateral circulation of the coronary arteries, primary PCI or venous thrombolysis were significantly lower in LVT group than those in non-LVT group (all P<0.05). The percentage of anti-platelet therapy and anticoagulant therapy was similar between the two groups (all P˃0.05). Subgroup analysis in patients undergoing primary PCI showed that onset to door, door to balloon, onset to balloon time were similar between the two groups. Multivariate logistic regression analysis and forest plot showed that history of heavy drinking (OR=6.982, 95%CI 1.501-32.469, P=0.013), anemia (OR=3.373, 95%CI 1.075-10.585, P=0.037), LVEF≤40% (OR=3.016, 95%CI 1.027-8.859, P=0.045), preoperative TIMI blood flow grade 0 (OR=3.311, 95%CI 1.214-9.029, P=0.019) were positively correlated with LVT in patients with acute STEMI and LVA. History of angina (OR=0.159, 95%CI 0.058-0.441, P<0.001), collateral circulation of the coronary arteries (OR=0.189, 95%CI 0.053-0.673, P=0.010), primary PCI or venous thrombolysis (OR=0.252, 95%CI 0.093-0.682, P=0.007) were negatively correlated with LVT in patients with acute STEMI and LVA. Conclusions: History of heavy drinking, anemia, LVEF ≤40%, preoperative TIMI blood flow grade 0 are associated with increased risk of the LVT in patients with acute STEMI and LVA at early stage of the disease. However, history of angina, collateral circulation of the coronary arteries, primary PCI or venous thrombolysis are associated with lower risk of the LVT in these patients.