PMID- 30871923
OWN - NLM
STAT- MEDLINE
DCOM- 20200129
LR  - 20220323
IS  - 1555-7162 (Electronic)
IS  - 0002-9343 (Linking)
VI  - 132
IP  - 8
DP  - 2019 Aug
TI  - Left Ventricular Thrombus After Primary PCI for ST-Elevation Myocardial 
      Infarction: 1-Year Clinical Outcomes.
PG  - 964-969
LID - S0002-9343(19)30228-1 [pii]
LID - 10.1016/j.amjmed.2019.02.033 [doi]
AB  - BACKGROUND: Left ventricular thrombus formation is a complication of acute 
      myocardial infarction. However, the incidence and risk of systemic 
      thromboembolism in the era of primary angioplasty for ST elevation myocardial 
      infarction (STEMI) is unclear. This study aims to determine clinical outcomes in 
      patients with STEMI treated with primary angioplasty and left ventricular 
      thrombus at 1 year. METHODS: Patients who underwent primary angioplasty for STEMI 
      and had a transthoracic echocardiogram were recruited. The primary endpoint was a 
      composite of all-cause mortality, stroke, and systemic thromboembolism at 1 year. 
      For the primary endpoint, the difference between the presence and absence of left 
      ventricular thrombus was compared using a logistic regression, adjusting for 
      minimization variables including age, diabetes mellitus, hypertension, and 
      previous stroke. RESULTS: Of 2608 patients who underwent primary angioplasty for 
      STEMI, 1645 (63%) patients had a transthoracic echocardiogram performed during 
      the index hospital admission. Forty patients (2.4%) had evidence of left 
      ventricular thrombus on transthoracic echocardiography. Patients with left 
      ventricular thrombus were more likely to develop atrial fibrillation in the 
      immediate postinfarction period (6 [15%] vs 87 [5.4%], P = 0.025). At 1 year, the 
      primary endpoint occurred in 4 (10%) patients with left ventricular thrombus and 
      146 (9.1%) who did not (logistic regression hazard ratio 0.79, 95% confidence 
      interval 0.23-2.70). CONCLUSIONS: In the contemporary era of mechanical 
      reperfusion for STEMI, echocardiographic detection of left ventricular thrombus 
      was observed in <3% patients. The presence of left ventricular thrombus was not 
      associated with an increased risk of systemic thromboembolism.
CI  - Crown Copyright (c) 2019. Published by Elsevier Inc. All rights reserved.
FAU - Moss, Alastair J
AU  - Moss AJ
AD  - British Heart Foundation Centre for Cardiovascular Science, University of 
      Edinburgh, Edinburgh, UK. Electronic address: alastairmoss@gmail.com.
FAU - Shah, Anoop S V
AU  - Shah ASV
AD  - British Heart Foundation Centre for Cardiovascular Science, University of 
      Edinburgh, Edinburgh, UK.
FAU - Zuling, Eunice T
AU  - Zuling ET
AD  - Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
FAU - Freeman, Michael
AU  - Freeman M
AD  - Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
FAU - Newby, David E
AU  - Newby DE
AD  - British Heart Foundation Centre for Cardiovascular Science, University of 
      Edinburgh, Edinburgh, UK.
FAU - Adamson, Philip D
AU  - Adamson PD
AD  - British Heart Foundation Centre for Cardiovascular Science, University of 
      Edinburgh, Edinburgh, UK; Christchurch Heart Institute, University of Otago, 
      Christchurch, New Zealand.
FAU - Cruden, Nicholas L
AU  - Cruden NL
AD  - Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
LA  - eng
GR  - WT103782AIA/WT_/Wellcome Trust/United Kingdom
GR  - FS/19/17/34172/BHF_/British Heart Foundation/United Kingdom
GR  - CGA/17/53/Chief Scientific Office/International
GR  - CH/09/002/BHF_/British Heart Foundation/United Kingdom
GR  - RE/13/3/30183/BHF_/British Heart Foundation/United Kingdom
GR  - CH/09/002/26360/BHF_/British Heart Foundation/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190311
PL  - United States
TA  - Am J Med
JT  - The American journal of medicine
JID - 0267200
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Aged
MH  - Anticoagulants/therapeutic use
MH  - Chi-Square Distribution
MH  - Echocardiography/methods
MH  - Electrocardiography/methods
MH  - Female
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Percutaneous Coronary Intervention/methods/*standards
MH  - ST Elevation Myocardial Infarction/physiopathology/*therapy
MH  - Thrombosis/complications/physiopathology/*therapy
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Anticoagulation
OT  - Clinical outcomes
OT  - Left ventricular thrombus
OT  - ST elevation myocardial infarction (STEMI)
EDAT- 2019/03/16 06:00
MHDA- 2020/01/30 06:00
CRDT- 2019/03/16 06:00
PHST- 2019/02/20 00:00 [received]
PHST- 2019/02/20 00:00 [revised]
PHST- 2019/02/21 00:00 [accepted]
PHST- 2019/03/16 06:00 [pubmed]
PHST- 2020/01/30 06:00 [medline]
PHST- 2019/03/16 06:00 [entrez]
AID - S0002-9343(19)30228-1 [pii]
AID - 10.1016/j.amjmed.2019.02.033 [doi]
PST - ppublish
SO  - Am J Med. 2019 Aug;132(8):964-969. doi: 10.1016/j.amjmed.2019.02.033. Epub 2019 
      Mar 11.