Clinical Predictive Study Of Primary Left Ventricular Thrombus Formation In Acute Anterior Wall Myocardial Infarction With Left Ventricular Dysfunction

Objective:Left ventricular thrombus(LVT),one of the most common complications of acute anterior myocardial infarction,is linked to the potentially devastating outcome of thromboembolism or stroke.In the era of primary percutaneous coronary intervention,(PCI)despite aggressive reperfusion treatment and anti-thrombotic treatment,the presence of LVT remains high after anterior ST-elevation myocardial infarction(STEMI).Recently,a prospective multicenter study showed that the incidence of LVT among patients with LV dysfunction after anterior myocardial infarction was up to 26%.Moreover,detection by standard echocardiography may underestimate the incidence,especially in such a high-risk group.The existing biomarkers,however,are not sufficient to predict which of the patients with anterior STEMI is prone to develop LVT,and the identification of additional early predictors would,therefore,be of benefit.This study was aimed to evaluate the predictors of primary LVT formation in patients with anterior STEMI and left ventricular(LV)dysfunction.Methods:In this matched case-control study,we screened 474 consecutive patients with acute anterior STEMI who underwent primary PCI from January 2017 to December 2019 at the China-Japan Union Hospital of Jilin University.Echocardiography was performed within 7 days after PCI.The LVT group(n= 46)was identified from anterior STEMI patients with LV dysfunction who were treated with primary PCI.The no-LVT group(n= 92)were also selected from the same batch of patients and were age-and sex-matched to the patients with LVT.The mean age of the subjects was61.01±11.51 years,and the males accounted for 79.7%.Results:The PLR were significantly higher in patients with LVT than in no-LVT group(p= 0.001).In a receiver operator characteristic curve(ROC)analysis,using a cut-off value of 118.07(AUC 0.673,95% CI: 0.574–0.771,P= 0.001),the PLR could independently predict the occurrence of LVT.using a cut-off value of 81.5(AUC:0.647,95%CI:0.550～0.745,P=0.005),the DTBT could independently predict the occurrence of LVT.Multivariate analysis showed that an increased PLR(OR = 1.011,95% CI: 1.004–1.018,P= 0.002),the presence of a left ventricular aneurysm(OR = 46.350,95%CI: 5.659–379.615,P< 0.001)and increased DTBT(OR = 1.005,95% CI:1.001–1.009,P= 0.012)were independent predictors of LVT formation.Conclusions:In acute anterior STEMI patients with LV dysfunction,an increased PLR and DTBT and the presence of an LV aneurysm were independent predictors of LVT formation.A larger prospective study is warranted to evaluate this result.