Impact of coronary revascularization on clinical outcomes of postacute myocardial infarction patients with left ventricular thrombus

Abstract

Background: The incidence of left ventricular thrombus (LVT), a significant complication postacute myocardial infarction (AMI), has seen a decline in the percutaneous coronary intervention era. Patients may not undergo coronary revascularization due to medical contraindications or patient preference. Objectives: This study compared post-AMI LVT patients treated with or without revascularization. Methods: This was a retrospective study of 263 consecutive post-AMI patients diagnosed with LVT from November 2012 to January 2021, retrieved from an echocardiography database. Patients were stratified by their revascularization status. Results: Mean (SD) follow-up duration was 2.1 ± 2.1 years. Most post-AMI LVT patients underwent revascularization via percutaneous coronary intervention (71.5%; n = 188). Unrevascularized patients (24.0%; n = 63) were older (P < .001), more often female (P < .001), more comorbid, less likely to have anterior AMI (P < .001), or treated with anticoagulation (P < .001). In multivariable analysis, at least anticoagulation + P2Y12 inhibitor (adjusted hazard ratio [aHR], 1.84; 95% CI, 1.14-2.96; P = .01), but not revascularization (aHR, 1.25; 95% CI, 0.74-2.13; P = .40), was associated with LVT resolution. Both absence of revascularization (aHR, 2.30; 95% CI, 1.09-4.85; P = .03) and LVT resolution (aHR, 6.06; 95% CI, 2.99-12.3; P < .001) were associated with higher mortality after adjusting for age, sex, anemia, anterior AMI, and ejection fraction. Conclusion: Lack of revascularization in post-AMI LVT patients was associated with higher mortality but not LVT resolution. Optimizing medical therapy remains a key treatment goal.

Keywords

• acute coronary syndrome
• anticoagulation
• left ventricular thrombus
• revascularization
• stroke