Incidence and Predictors of Early Left Ventricular Thrombus After ST-Elevation Myocardial Infarction in the Contemporary Era of Primary Percutaneous Coronary Intervention
Incidence and Predictors of Early Left Ventricular Thrombus After ST-Elevation Myocardial Infarction in the Contemporary Era of Primary Percutaneous Coronary Intervention
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DOI：
10.1016/j.amjcard.2013.12.015
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发表时间：
2014-04-01
影响因子：
2.8
通讯作者：
MacCarthy, Philip
中科院分区：
文献类型：
--
作者：
Gianstefani, Silvia;Douiri, Abdel;MacCarthy, Philip
本研究的目的是确定在直接经皮介入（pPCI）和超声造影的当代左心室血栓（LVT）的发生率及其预测因素。我们回顾性分析了1,059例ST段抬高型心肌梗死（STEM！）送到我们的三级心脏中心接受pPCI治疗术前药理学和手术技术（包括入路、药物洗脱支架的使用和血栓切除术）由术者自行决定。出院前进行经胸超声心动图检查;适当时使用超声造影剂。在42名受试者（4%）中检测到LVT。两组之间的基线人口统计学或PCI前临床特征无显著差异。治疗后，LVT患者的平均射血分数（EF）为35 +/- 8.4%，而无LVT患者为47 +/-10%，p < 0.001。LVT组中37例患者（88%）出现前壁STEMI，而无LVT组中471例患者（42%）出现前壁STEMI（p < 0.001）。在所有LVT患者中均观察到心尖部运动不能，无论MI的主要位置如何。LVT的多变量分析预测因子是EF降低、MI的前部和血小板糖蛋白抑制剂的使用。诊断为LVT后，患者接受华法林治疗3至6个月。出院时，两组之间的死亡率无显著差异。总之，在pPCI的当代，STEMI患者的LVT发生率显著低于既往（溶栓）文献。LVT的早期存在更可能发生在前部STEMI（涉及心尖）和EF降低的患者中。(C)2014爱思唯尔公司All rights reserved.
The aim of this study was to define the incidence of left ventricular thrombus (LVT) and its predictors in the contemporary era of primary percutaneous intervention (pPCI) and contrast echocardiography. We retrospectively analyzed 1,059 patients presenting with ST-elevation myocardial infarction (STEM!) to our tertiary cardiac center and treated with pPCI. Preprocedural pharmacology and procedural technique (including access route, the use of drug-eluting stents, and thrombectomy) were at the operators' discretion. Transthoracic echocardiography was performed before discharge; echo contrast agent was used when appropriate. LVT was detected in 42 subjects (4%). There were no significant differences in baseline demographics or pre-PCI clinical features between the 2 groups. Post-treatment, mean ejection fraction (EF) in patients with LVT was 35 +/- 8.4% and in those without LVT was 47 +/- 10%, p < 0.001. Thirty-seven patients (88%) in the LVT group presented with an anterior STEMI versus 471 patients (42%) in the without LVT group (p < 0.001). Apical akinesis was noted in all patients with LVT irrespective of the principal location of the MI. Multivariate analysis predictors of LVT were reduced EF, anterior site of MI, and the use of platelet glycoprotein inhibitors. After diagnosis of LVT, patients were treated with warfarin for 3 to 6 months. No significant difference in mortality was detectable at discharge between the 2 groups. In conclusion, in the contemporary era of pPCI, the incidence of LVT in patients with STEMI is significantly lower than that of the previous (thrombolysis) literature. The early presence of LVT is more likely in patients with anterior STEMI (involving the apex) and reduced EF. (C) 2014 Elsevier Inc. All rights reserved.