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Late presenters with ST-elevation myocardial infarction and thromboembolic complications: a treatment challenge: a
Małgorzata Wojciechowska1, Karol Momot2, Jakub Tomaszewski1
1Chair and Department of Experimental and Clinical Physiology, Laboratory of the Centre for Preclinical Research Medical, University of Warsaw, Warsaw, Poland.
Insights
Late presentation of ST-elevation myocardial infarction (STEMI) increases risks, especially left ventricular thrombus. This study examines revascularization and anticoagulation strategies for STEMI latecomers, highlighting cardiac surgery for large thrombi.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Late presentation of ST-elevation myocardial infarction (STEMI) presents significant treatment challenges.
- The COVID-19 pandemic exacerbated STEMI late presentations and associated complications like left ventricular thrombus.
- Refined management strategies are crucial for STEMI latecomers.
Purpose of the Study:
- To discuss the role of revascularization in STEMI latecomers.
- To evaluate the use of direct oral anticoagulants for left ventricular thrombus.
- To highlight surgical options for large left ventricular thrombi.
Main Methods:
- Case presentation of two STEMI latecomers with left ventricular thrombus and CNS complications.
- Discussion of revascularization strategies.
- Review of current knowledge on left ventricular thrombus management.
Main Results:
- Left ventricular thrombus is common in STEMI latecomers.
- Direct oral anticoagulants have a role in treatment.
- Cardiac surgery may be necessary for large thrombi.
Conclusions:
- Left ventricular thrombus remains a significant concern in STEMI latecomers.
- Further research is needed to optimize management strategies.
- Individualized treatment approaches are essential.
Background:
Late presenters with ST-elevation myocardial infarction pose a considerable challenge in the field of cardiovascular medicine. These individuals, who delay seeking medical attention after the onset of ST-elevation myocardial infarction symptoms, often face substantial difficulties in treatment. The coronavirus disease 2019 pandemic led to a significant increase in the number of late presenters. By increasing the frequency of complications such as thromboembolic events in the course of left ventricular thrombus, the pandemic necessitated the refinement of existing management strategies.
Case Presentation:
In this paper, we present two White male patients of Central European (Polish) descent (50 and 64 years old) who, although reported to have had acute ST-elevation myocardial infarction, turned out to be ST-elevation myocardial infarction latecomers. In both cases, we were dealing with the presence of left ventricular thrombus and complications related to the central nervous system. On the basis of these two patients, we discuss the role of revascularization in latecomer ST-elevation myocardial infarction patients. We present the position of direct oral anticoagulants in the left ventricular thrombus treatment and show that, in limited cases of a huge thrombus, cardiac surgery is a treatment of choice.
Conclusions:
As left ventricular thrombus is still relatively common in ST-elevation myocardial infarction latecomers, we present the current state of knowledge on this topic, emphasizing the need for further research in this area.
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