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Predischarge two-dimensional echocardiographic evaluation of left ventricular thrombosis after acute myocardial
F Chiarella1, E Santoro, S Domenicucci
1Divisione di Cardiologia, E.O. Ospedali Galliera, Genova, Italy.
Insights
Left ventricular thrombosis occurred in 5.1% of patients after acute myocardial infarction (AMI). Anterior AMI and reduced ejection fraction (<40%) significantly increased this risk, with Killip class > I and early IV beta-blockers being independent risk factors.
Area of Science:
- Cardiology
- Clinical Medicine
- Cardiovascular Research
Background:
- Left ventricular (LV) thrombosis is a known complication of acute myocardial infarction (AMI).
- Previous large multicenter trials on AMI have not extensively reported on LV thrombosis incidence.
- The GISSI-3 study protocol included LV thrombosis assessment in a large patient cohort.
Purpose of the Study:
- To determine the incidence of LV thrombosis in a large cohort of low-to-medium risk AMI patients.
- To identify predictors of LV thrombosis, particularly in patients with anterior AMI.
Main Methods:
- Analysis of the GISSI-3 database, including 8,326 patients with available predischarge echocardiograms.
- Stratification of patients based on AMI location (anterior vs. other sites) and ejection fraction.
- Multivariate analysis to identify independent risk factors for LV thrombosis.
Main Results:
- LV thrombosis was detected in 5.1% of patients (427/8,326).
- Anterior AMI patients had a significantly higher incidence (11.5%) compared to other sites (2.3%).
- Reduced ejection fraction (<40%) was associated with higher LV thrombosis rates in both total and anterior AMI groups.
- Killip class > I and early intravenous beta-blocker administration were independently associated with increased LV thrombosis risk in anterior AMI patients.
Conclusions:
- The highest incidence of LV thrombosis in this low-to-medium risk population was observed in patients with anterior AMI and ejection fraction <40%.
- Killip class > I and early intravenous beta-blocker administration are significant independent predictors of LV thrombosis after anterior AMI.
- Oral beta-blocker therapy, nitrates, and lisinopril did not show a significant influence on LV thrombosis occurrence in this study.
Abstract:
Left ventricular (LV) thrombosis can be found in patients with acute myocardial infarction (AMI). No wide multicenter trial on AMI has provided information about LV thrombosis until now. The protocol of the GISSI-3 study included the search for the presence of LV thrombosis in patients from 200 coronary care units that did not specifically focus on LV thrombosis. We examined the GISSI-3 database results related to 8,326 patients at low to medium risk for LV thrombi in which a predischarge echocardiogram (9 +/- 5 days) was available. LV thrombosis was found in 427 patients (5.1%): 292 of 2,544 patients (11.5%) with anterior AMI and in 135 of 5,782 patients (2.3%) with AMI in other sites (p <0.0001). The incidence of LV thrombosis was higher in patients with ejection fraction < or = 40% (151 of 1,432 [10.5%] vs 276 of 6,894 [4%]; p <0.0001) both in the total population and in the subgroup with anterior AMI (106 of 597 [17.8%] vs 186 of 1,947 [9.6%]; p <0.0001). Multivariate analysis showed that only the Killip class > I and early intravenous beta-blocker administration were independently associated with higher LV thrombosis risk in the subgroup of patients with anterior AMI (odds ratio 1.75, 95% confidence interval 1.28 to 2.39; odds ratio 1.32, 95% confidence interval 1.02 to 1.72, respectively). In patients with anterior AMI, oral beta-blocker therapy given or not given after early intravenous beta-blocker administration does not influence the occurrence of LV thrombosis. The rate of LV thrombosis was similar in patients treated or not treated with nitrates and lisinopril both in the total population and in patients with anterior and nonanterior AMI. In conclusion, in the GISSI-3 population at low to medium risk for LV thrombi, the highest rate of occurrence of LV thrombosis was found among patients with anterior AMI and an ejection fraction < 40%. Killip class > I and the early intravenous beta-blocker administration were the only variables independently associated with a higher predischarge incidence of LV thrombosis after anterior AMI.