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Risk factors for embolisation in patients with left ventricular thrombi and acute myocardial infarction
K A Johannessen1, J E Nordrehaug, G von der Lippe
1Cardiology Section, Diakonissehjemmets Hospital, Bergen, Norway.
Insights
Systemic embolisation risk in acute myocardial infarction patients with ventricular thrombi is high. Patient age over 68 and specific echocardiographic thrombus features accurately predict this risk.
Area of Science:
- Cardiology
- Thrombosis Research
Background:
- Acute myocardial infarction (AMI) can lead to left ventricular thrombi (LVT).
- Systemic embolisation is a significant complication of LVT, posing a risk to patients.
Purpose of the Study:
- To identify risk factors for systemic embolisation in patients with LVT post-anterior wall AMI.
- To develop a predictive model for embolisation risk based on patient and thrombus characteristics.
Main Methods:
- Prospective study of 150 consecutive anterior wall AMI patients.
- Serial echocardiograms performed 2-10 days post-event, with 3-month follow-up.
- Logistic regression analysis to identify predictors of embolisation.
Main Results:
- 15 of 55 patients (27%) with LVT developed peripheral emboli; only 2 of 95 (2%) without LVT did.
- Key predictors of embolisation included age > 68 years, pendulous thrombus, and independent thrombus mobility.
- A predictive formula incorporating age, thrombus area, and length demonstrated high sensitivity (87%) and specificity (88%).
Conclusions:
- Systemic embolisation risk from LVT in anterior AMI can be accurately assessed.
- Patient age and echocardiographic thrombus features are crucial for risk stratification.
- High-risk patients include those with LVT and age over 68 years.
Abstract:
Risk factors for systemic embolisation in patients with ventricular thrombi caused by an acute myocardial infarction were studied in 150 consecutive patients with an infarction of the anterior wall. Serial echocardiograms were performed 2-10 days after the acute event and patients were followed up for three months. Anticoagulation treatment was started only after the detection of thrombi. Of the 55 patients in whom a thrombus developed, 15 (27%) had peripheral emboli between 6-62 days; but only two (2%) of 95 patients without thrombus had emboli. Among 15 variables, the best single predictors of embolisation were age greater than 68 years (80% sensitive, 85% specific), pendulous thrombus (60%, 93%), and independent thrombus mobility (60%, 85%). Logistic regression analysis showed that a formula that included patient age, thrombus area, and the length of thrombus in the ventricular lumen predicted embolisation (sensitivity 87%, specificity 88%). There was no correlation between age and the thrombus variables. The risk of embolisation from left ventricular thrombi in acute anterior myocardial infarction can be accurately assessed from patient age and echocardiographic features. The risk of peripheral emboli is high in patients with left ventricular thrombi and those aged greater than 68.