Predictors and prognosis of left ventricular thrombus in postmyocardial infarction patients with left ventricular dysfunction after percutaneous coronary intervention

Jieyun You, Xingxu Wang, Jian Wu, Liming Gao, Xiaoyan Wang, Peizhao Du, Haibo Liu, Jiming Li, Yunkai Wang, Yulu Liang, Wei Guo, Qi Zhang


Background: We aimed to investigate the predictors and prognosis of left ventricular thrombus (LVT) in patients admitted for post-myocardial infarction (MI) and left ventricular dysfunction after contemporary percutaneous coronary intervention (PCI).
Methods: We prospectively enrolled 267 consecutive post-MI patients with left ventricular ejection fraction (LVEF) <0.45 based on the Shanghai East Hospital PCI database since 2012. Altogether 25 (9.36%) patients were selected as the LVT group. Baseline, angiographic, procedural characteristics and 1-year clinical outcomes were compared by Chi-square test, t-test or Kaplan-Meier survival analysis as appropriate. Receiver operating characteristic (ROC) curves were plotted for the accuracy of the multivariate analysis model. A multiple logistic regression was applied to predict LVT formation.
Results: The independent risk factors of LVT were left ventricular aneurysm [odds ratio (OR): 1.29, 95% confidence interval (CI): 1.09–1.52, P<0.01], incomplete revascularization (OR: 0.05, 95% CI: 0.01–0.35, P<0.01), SYNTAX score (OR: 1.28, 95% CI: 1.14–1.43, P<0.01) and D-dimer (OR: 1.90, 95% CI: 1.19–3.04, P<0.01). The SYNTAX score and D-dimer effectively indicated the development of LVT with optimal cutoff values of 29.50 and 1.53 mg/L, respectively. Patients with LVT had significantly worse outcomes at 1-year clinical follow-up, especially higher incidence of ischemic or hemorrhagic stroke.
Conclusions: This study indicated that the presence of left ventricular aneurysm, incomplete revascularization, higher SYNTAX score and D-dimer level were the independent predictors of LVT formation in post-MI and LV dysfunction patients, which related to worse clinical outcomes. Future studies for early intervention and complete revascularization in high-risk subgroup patients are expected.