Background: Patients with acute myocardial infarction (AMI) especially those with large MI (myocardial infarction) as
identified by ST elevation in multiple contiguous ECG leads or anterior MI, may suffer significant myocardial damage
leading to impaired wall motion and contractility which may lead to the formation of left ventricular thrombus (LVT) in
the patient. This study was aimed to establish the incidence of LV thrombus and determine the predictors associated
with the formation of LV thrombus in patients with AMI.
Methods: This retrospective study was held at the only cardiothoracic centre of Makkah, which provides tertiary level
cardiac services. A total of 3084 consecutive patients with acute MI between 2016 and 2019 were identified and divided
into two groups i.e. group I (with LVT) and group II (without LVT). The case notes, echocardiography data and cardiac
catheterization lab records were reviewed to identify patients with LV thrombus. Regression analysis was employed to
evaluate the predictors responsible for the formation of LV thrombus.
Results: The overall incidence for LV thrombus was determined as 8.4% (n ¼ 260/3084), while in the subpopulation of
pilgrims, it was 8.2% (83/1001). Mean age for patients with and without LVT was 54 ± 11 years vs 56 ± 12 years
(p < 0.003), respectively. There was no significant difference between the two groups with respect to gender, diabetes,
hypertension, smoking, Arabic speaking or BMI>30. Coronary thrombus aspiration was utilized in 17% vs 12%
(p < 0.023) patients with LVT and without LVT, respectively. It was observed that the patients with cardiac arrest tend to
develop more LVT i.e. 8.5% vs 5.2% (p < 0.033). However, LV thrombus formation was significantly associated with
anterior STEMI with incidence of LVT reaching 13.4% and low ejection fraction (all MI types) i-e. 32 ± 9% vs 42 ± 11%,
with p < 0.000 for both independent predictors.
Conclusions: LV thrombus is a relatively common occurrence in patients with acute MI, especially those with anterior
STEMI and low ejection fraction |
