Predictors Of Left Ventricular Apical Thrombus Formation in Patients With Acute Anterior Myocardial Infarction and Treated Primary Percutaneous Coronary Intervention: Importance of Syntax Score
Öz
Aim: Left ventricular (LV) apical thrombus development is one of the important advers event patients with anterior ST elevation myocardial infarction (STEMI) and accompanies with LV apical aneurysm and systolic dysfunction. SYNTAX score is an important determinant of cardiovascular morbidity and mortality in patients with coronary artery disease. We aimed that the relationship between LV apical thrombus and SYNTAX score and other clinical risk factors patients with anterior STEMI
Methods: A total of 205 consecutive anterior STEMI patients undergoing primary PCI (35 female/ 170 male mean age: 55.8 ± 9.6 years) were included in our study. We assessed the severity and complexity of coronary artery disease by using SYNTAX score. The patients were divided into two groups; patients with apical thrombus (n=19) and patients without apical thrombus(n=186).
Results: We found that systolic and diastolic blood pressure were lower patients with apical thrombus groups. (p<0.001 for both). Syntax score was higher and LV ejection fraction (LVEF) is lower in patients with apical thrombus (p<0.001 for both). We also showed that LV apical thrombus formation was independently associated with lower systolic blood pressure (p=0.006), SYNYAX score (p=0.003), and depressed LVEF (p=0.001).
Conclusion: In this study, impaired LVEF, lower systolic blood pressure and SYNTAX score have been found to be predictors of LV thrombus generation. Patients presenting with anterior myocardial infarction who have high SYNTAX scores (> 18.25) at PPCI should be followed up closely.
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- 1. Ellen C Keeley , Judith A Boura, Cindy L Grines. Comparison of primary and facilitated percutaneous coronary interventions for ST-elevation myocardial infarction: quantitative review of randomised trials. Lancet. 2006 Feb 18;367(9510):579-88. doi: 10.1016/S0140-6736(06)68148-8.
- 2. Franz-Josef Neumann, Miguel Sousa-Uva, Anders Ahlsson, Fernando Alfonso, Adrian P Banning, Umberto Benedetto, et al. ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal, Volume 40, Issue 2, 07 January 2019, Pages 87–165, https://doi.org/10.1093/eurheartj/ehy394
- 3. Duk-Woo Park, Robert M Clare, Phillip J Schulte, Karen S Pieper, Linda K Shaw, Robert M Califf,, et al. Extent, location, and clinical significance of non-infarct-related coronary artery disease among patients with ST-elevation myocardial infarction. JAMA. 2014 Nov 19;312(19):2019-27. doi: 10.1001/jama.2014.15095.
- 4. Yoshihiro Seo, Hiroshi Maeda, Tomoko Ishizu, Toshiyuki Ishimitsu, Shigeyuki Watanabe, Kazutaka Aonuma et al. Peak c-reactive protein concentration correlates with left ventricular thrombus formation diagnosed by contrast echocardiographic left ventricular opacification in patients with a first anterior acute myocardial infarction. Circ J. 2006;70:1290-1296.
- 5. C M O'Connor, R M Califf, E W Massey, D B Mark, D J Kereiakes, R J Candela, et al. Stroke and acute myocardial infarction in the thrombolytic era: Clinical correlates and long-term prognosis. J Am Coll Cardiol. 1990;16:533-540
- 6. F Chiarella, E Santoro, S Domenicucci, A Maggioni, C Vecchio. Predischarge Two-dimensional echocardiographic evaluation of left ventricular thrombosis after acute myocardial infarction in the gissi-3 study. The American journal of cardiology. 1998;81:822-827.
- 7. Svein Solheim , Ingebjørg Seljeflot, Ketil Lunde, Reidar Bjørnerheim, Svend Aakhus, Kolbjørn Forfang, et al. Frequency of left ventricular thrombus in patients with anterior wall acute myocardial infarction treated with percutaneous coronary intervention and dual antiplatelet therapy. The American Journal of Cardiology. 2010;106:1197-1200
- 8. Tullio Palmerini, Adriano Caixeta, Philippe Genereux, Ecaterina Cristea, Alexandra Lansky, Roxana Mehran,, et al. Comparison of clinical and angiographic prognostic risk scores in patients with acute coronary syndromes: Analysis from the acute catheterization and urgent intervention triage strategy (acuity) trial. Am Heart J. 2012;163:383-391, 391 e381-385.
- 9. Gabriel Steg, Stefan K James, Dan Atar, Luigi P Badano, Carina Blömstrom-Lundqvist, Michael A Borger, et al. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC); ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33:2569–619.
- 10. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). J Am Med Assoc 2001;285:2486–97