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Clinical predictors and outcomes of patients with left ventricular thrombus following ST-segment elevation myocardial infarction

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Abstract

We aimed to characterize the independent predictors of LVT following STEMI and the association with outcomes. The clinical predictors of left ventricular thrombus (LVT) formation after ST-segment elevation myocardial infarction (STEMI) are not well-defined in the contemporary era. We performed a retrospective analysis of STEMI patients at Duke from 2000 to 2011 who had a transthoracic echocardiogram within 90 days post-STEMI and compared patients with and without LVT (LVT+ vs. LVT−). Univariate Cox proportional hazards regression models of baseline characteristics were examined and significant variables were used in a multivariable model to assess adjusted relationships with LVT. A multivariable Cox PH survival model with covariate adjustments was used for assessment of LVT and long-term mortality. Of all eligible patients, 1734 patients met inclusion criteria and 4.3 % (N = 74) had a LVT. LVT+ patients tended to have a history of heart failure (HF) and higher initial troponin compared to LVT- patients. After adjustment, higher heart rate, non-white race, HF severity, and presence of left anterior descending artery (LAD) disease were independent predictors of LVT. There was a trend toward an association between LVT and increased all-cause mortality (HR 1.36; 95 % CI 0.84–2.21, P = 0.22), however this was not statistically significant. LVT was seen in over 4 % of this contemporary post-STEMI population. Several baseline characteristics were independently associated with LVT: Heart rate, HF severity, LAD disease, and non-white race. Prospective studies are warranted to determine whether anticoagulation in patients at increased risk for LVT improves outcomes.

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Abbreviations

LVT:

Left ventricular thrombus

HF:

Heart failure

AMI:

Acute myocardial infarction

STEMI:

ST-segment elevation myocardial infarction

TTE:

Transthoracic echocardiogram

PCI:

Percutaneous coronary intervention

EF:

Ejection fraction

IQR:

Interquartile range

DDCD:

Duke Databank for Cardiovascular Disease

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Funding

No extramural funding. Mentz, R: supported by Grant Number 5-T32GM086330 from the National Institute of General Medical Sciences. Fiuzat, M and O’Connor, C: Roche Diagnostics—research Grants; Velazquez, E: Consulting Fees/Honoraria: Novartis Pharmaceuticals Corp.; Research/Research Grants: Ikaria Pharmaceuticals; supported by grants from the National Institute of Health.

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Authors and Affiliations

  1. Department of Internal Medicine, Virginia Commonwealth University, 1200 East Broad St., P.O. Box 980102, Richmond, VA, 23298-0102, USA

    Adam M. Garber

  2. Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Robert J. Mentz, Christopher M. O’Connor & Eric J. Velazquez

  3. Department of Medicine, Duke Clinical Research Institute, Durham, NC, USA

    Hussein R. Al-Khalidi, Linda K. Shaw & Eric J. Velazquez

  4. Division of Clinical Pharmacology, Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Mona Fiuzat

Authors
  1. Adam M. Garber
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  2. Robert J. Mentz
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  3. Hussein R. Al-Khalidi
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  4. Linda K. Shaw
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  5. Mona Fiuzat
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  6. Christopher M. O’Connor
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  7. Eric J. Velazquez
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Corresponding author

Correspondence to Adam M. Garber.

Additional information

Dr. Garber completed the project while working at Duke, finished the manuscript after taking new position at VCU.

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Garber, A.M., Mentz, R.J., Al-Khalidi, H.R. et al. Clinical predictors and outcomes of patients with left ventricular thrombus following ST-segment elevation myocardial infarction. J Thromb Thrombolysis 41, 365–373 (2016). https://doi.org/10.1007/s11239-015-1252-0

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