CARDIOEMBOLIC AND BLEEDING OUTCOMES OF PATIENTS TREATED FOR LEFT VENTRICULAR THROMBUS FOLLOWING PRIMARY PERCUTANEOUS INTERVENTION FOR ST-ELEVATION MYOCARDIAL INFARCTION

Abstract

Left ventricular thrombus (LVT) is an important complication of acute myocardial infarction. At present, there is limited data in the literature regarding the rates of LVT following ST-elevation myocardial infarction (STEMI) treated with primary percutaneous intervention (PCI). Even less is known about rates of cardioembolism and bleeding among patients being treated for LVT. A retrospective, single center study of 616 consecutive patients who underwent primary PCI for STEMI between 2013 and 2016 was conducted. Patients were included if they had successful PCI and had an inpatient echocardiogram. Echocardiogram reports were reviewed to determine the number of patients who developed LVT. Two year outcomes of patients with LVT were determined using provincial databases and hospital records. Cardioembolic events were identified based on clinical and radiographic characteristics. All bleeding events were also identified and classified based on the TIMI bleeding scale. 42 of 616 patients (6.8%) were found to have definite, possible, or suspicious LVT on echocardiogram. Anterior STEMI, male sex, duration of ischemic time, ejection fraction, and end-diastolic pressure were found to be associated with development of LVT. 40 patients were discharged on aspirin, a P2Y12 inhibitor, and an oral anticoagulant. Average duration of “triple therapy” was 6.4 months. In two years following the index STEMI, one patient (2.5%) suffered a cardioembolic event. 7 patients (18.5%) suffered bleeding events. Rates of LVT following successful PCI for STEMI are relatively low and are primarily related to anterior myocardial infarction. While the risk of cardioembolic events was low, there was substantial risk of bleeding related to the use of oral anticoagulation and dual antiplatelet therapy. Careful selection of drugs is required to reduce the risk of bleeding in this cohort. Prospective, randomized clinical trials are needed to determine the best treatment for these patients.