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Contemporary incidence and predictors of left ventricular thrombus in patients with anterior acute myocardial infarction

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Abstract

Background

The incidence of left ventricular thrombus (LVT) after anterior acute myocardial infarction (AMI) has not been well established in the era of primary percutaneous coronary intervention (pPCI) and potent dual antiplatelet therapy. The objective of this study is to establish the contemporary incidence of LVT in this population, to identify their risk factors, and to examine their association with clinical outcomes.

Methods

A multicenter retrospective cohort study including AMI patients with new-onset antero-apical wall motion abnormalities treated with pPCI between 2009 and 2017 was conducted. The primary outcome was LVT during the index hospitalization. Predictors of LVT were identified using multivariate logistic regression. Net adverse clinical events (NACE), a composite of mortality, myocardial infarction, stroke or transient ischemic attack, systemic thromboembolism or BARC type 3 or 5 bleeding at 6 months were compared between the LVT and no LVT groups.

Results

Among the 2136 patients included, 83 (3.9%) patients developed a LVT during index hospitalization. A lower left ventricular ejection fraction (LVEF) [adjusted odds ratio (aOR) 0.97; 95% confidence intervals (CI) 0.94–0.99] and the degree of worse anterior WMA (aOR 4.34; 95% CI 2.24–8.40) were independent predictors of LVT. A NACE occurred in 5 (5.72 per 100 patient-year) patients in the LVT group and in 127 (6.71 per 100 patient-year) patients in the no LVT group at 6 months [adjusted hazard ratio (aHR): 0.87; 95% CI 0.35–2.14].

Conclusions

The risk of LVT after anterior AMI with new-onset wall motion abnormalities is low, but this complication remains present in the contemporary era of timely pPCI and potent dual antiplatelet therapy .

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Data Availability

The dataset of this study will not be available.

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Acknowledgements

GMG is supported by the Fonds de Recherche Santé Quebec (FRSQ) Junior 1 clinician scholars’ program.

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Authors and Affiliations

  1. Université de Montréal, Montreal, QC, Canada

    Laurie-Anne Boivin-Proulx, Fabrice Ieroncig, Simon-Pierre Demers, Marwa Soltani, Ismahane Ghersi, Charles Massie, Philippe Simard, Lorena Rosca, Jean G. Diodati, Nicolas Pranno, Marc Jolicoeur, Brian J. Potter & Guillaume Marquis-Gravel

  2. CHUM Research Center and Cardiovascular Center, Montreal, QC, Canada

    Laurie-Anne Boivin-Proulx & Brian J. Potter

  3. Montreal Heart Institute, 5000 Belanger, Montreal, Qc, H1T 1C8, Canada

    Fabrice Ieroncig, Simon-Pierre Demers, Anna Nozza, Ismahane Ghersi, Marc Jolicoeur & Guillaume Marquis-Gravel

  4. Sherbrooke University Hospital Center, Sherbrooke, QC, Canada

    Louis Verreault-Julien & Benoit Daneault

  5. Division of Cardiology, Department of Medicine, Jewish General Hospital and McGill University, Montreal, QC, Canada

    Yahya Alansari & Annabel Chen-Tournoux

  6. Cardiology Division, CIUSSS-NÎM, Sacré-Coeur Hospital, Montreal, QC, Canada

    Charles Massie & Jean G. Diodati

  7. Quebec Heart and Lung Institute, Quebec, QC, Canada

    Jean-Simon Lalancette, Gabriel Massicotte & Jean-Michel Paradis

  8. Maisonneuve-Rosemont Hospital, Montreal, QC, Canada

    Marwa Soltani & Nicolas Pranno

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  1. Laurie-Anne Boivin-Proulx
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Corresponding author

Correspondence to Guillaume Marquis-Gravel.

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Conflict of interest

The project was partly funded by a grant from the Société Québécoise d’Insuffisance Cardiaque (Montréal, Quebec, Canada). Dr. Marquis-Gravel has received honoraria or speaker fees from Novartis, CSI, Boston Scientific, Bayer, JAMP Pharma, and KYE Pharmaceuticals and has received research funding from Bayer. The other authors report no financial relationships or conflicts of interest regarding the content herein.

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Boivin-Proulx, LA., Ieroncig, F., Demers, SP. et al. Contemporary incidence and predictors of left ventricular thrombus in patients with anterior acute myocardial infarction. Clin Res Cardiol 112, 558–565 (2023). https://doi.org/10.1007/s00392-023-02158-8

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  • DOI: https://doi.org/10.1007/s00392-023-02158-8

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