Abstract 17791: Predictors of Left Ventricular Thrombus Following ST-Segment Elevation Myocardial Infarction: Findings From the Duke Databank of Cardiovascular Disease and the Duke Echocardiography Databank
Background: The clinical characteristics predictive of left ventricular thrombus (LVT) formation after ST-segment elevation myocardial infarction (STEMI) are not well defined in the contemporary era. We aimed to characterize the independent baseline predictors of LVT following STEMI and the association with outcomes.
Methods: We performed a retrospective analysis of all patients treated for STEMI at Duke from 2000-2010 who had a transthoracic echocardiogram (TTE) within 90 days post-STEMI and compared patients with and without LVT (LVT+ vs. LVT-). LVT was defined as single, multiple or probable apical thrombus on TTE. 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.
Results: Of all eligible patients, 1734 patients met inclusion criteria and 4.3% (N=74) had a LVT. LVT+ patients tended to be of non-white race, with a history of heart failure (HF), worse baseline NYHA class, higher heart rate, and initial troponin and CK-MB compared to LVT- patients (P<0.05). After multivariable adjustment, higher heart rate, non-white race, history of HF and HF severity, and presence of left anterior descending artery disease were independent predictors of LVT (Figure). 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.
Conclusion: LVT was seen in over 4% of this contemporary post-STEMI population. Although LVT remains difficult to predict in this patient population, several baseline characteristics were independently associated with LVT. Prospective studies are warranted to determine whether anticoagulation in patients at increased risk for LVT improves outcomes.
- © 2013 by American Heart Association, Inc.