In-hospital left ventricular thrombus following ST-elevation myocardial infarction
In-hospital left ventricular thrombus following ST-elevation myocardial infarction
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DOI：
10.1016/j.ijcard.2019.07.070
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发表时间：
2020-01-15
影响因子：
3.5
通讯作者：
Khalife, Wissam I.
中科院分区：
文献类型：
--
作者：
Albaeni, Aiham;Chatila, Khaled;Khalife, Wissam I.
背景资料：急性ST段抬高型心肌梗死（STEMI）后的院内左心室（LV）血栓尚未在全国范围内进行评估，这是本研究的重点。方法：我们使用2003年至2013年全国住院患者样本数据库，以确定ST段抬高型心肌梗死为主要诊断代码的≥ 18岁成人。根据是否存在LV血栓将患者分为两组。使用相关统计学研究临床特征和住院结局。结果：2003年至2013年，在美国住院的1，035，888名STEMI患者中，1982名（0.2%）发生了急性院内左心室血栓。与无LV血栓相比，LV血栓患者更可能发生院内并发症;急性缺血性和出血性卒中、急性肾衰竭、胃肠道出血、心源性休克、院内心脏骤停和死亡。他们也有更长的平均住院时间和更高的医院费用。与LV血栓相关的因素包括：前/前外侧STEMI、急性或慢性心力衰竭伴射血分数降低、房颤、LV动脉瘤、左心瓣膜病、急性或慢性深静脉血栓形成/肺栓塞和酗酒。结论：明确STEMI后早期发生左室血栓的相关因素，将有助于为特定高危人群提供资源，并促进经济有效的治疗。LV血栓形成的性别差异需要进一步研究。(C)2019 Elsevier B. V.版权所有。
Background: In-hospital left ventricular (LV) thrombus following acute ST-elevation myocardial infarction (STEMI) has not been evaluated on a national scale and was the focus of this investigation.Methods: We used the 2003 to 2013 Nationwide Inpatient Sample database to identify adults >= 18 years old with a principal diagnosis code of ST-elevation myocardial infarction. Patients were divided into two groups defined by the presence or absence of LV thrombus. Clinical characteristics and in-hospital outcomes were studied using relevant statistics. Multiple linear and logistic regression models were conducted to identify factors associated with LV thrombus.Results: Of 1,035,888 STEMI patients hospitalized in the U.S from 2003 to 2013, 1982 (0.2%) developed acute in-hospital LV thrombus. Compared to no LV thrombus, patients with LV thrombus were more likely to have in-hospital complications; acute ischemic and hemorrhagic stroke, acute renal failure, gastrointestinal bleed, cardiogenic shock, in-hospital cardiac arrest and mortality. They also had longer mean length of stay and higher hospital charges. Factors associated with LV thrombus included: anterior/anterolateral STEMI, acute or chronic heart failure with reduced ejection fraction, atrial fibrillation, LV aneurysm, Left heart valvular disease, acute or chronic deep venous thrombosis/pulmonary embolism and alcohol abuse. Patients with LV thrombus were less likely to be female [AOR 0.66, 95% CI (0.51-0.84)].Conclusion: The identification of factors associated with early development of LV thrombus following STEMI, will help direct resources for specific high-risk group and prompt cost-effective therapies. Gender variability in LV thrombus development warrants further investigations. (C) 2019 Elsevier B.V. All rights reserved.