Left ventricular mural thrombus after anterior ST-segment-elevation acute myocardial infarction in the era of aggressive reperfusion therapy - still a frequent complication

Background Left ventricular mural thrombus (LVMT) is a well-known complication of anterior ST-elevation acute myocardial infraction (AMI). It remains unknown how modern therapies have impacted on its occurrence. Objectives To define the frequency of LVMT among contemporary patients with anterior ST-elevation AMI, the clinical and echocardiographic predictors of LVMT formation, and the intermediate-term outcomes of patients with LVMT. Methods We retrospectively analysed patients (in the years 1997-2002) with a diagnosis of anterior ST-elevation AMI and no prior AMI, and who underwent a thorough echocardiographic assessment within 72 h of admission. Stepwise logistic regression analysis was used to define predictors of LVMT formation. Survival was calculated by the Kaplan-Meier product-limit method. Results Of the 153 patients with complete data, LVMT was detected in 36 (23.5%). There were no significant differences in baseline demographic and clinical variables between LVMT and non-LVMT patients, or in treatments (all patients received reperfusion treatment). The mean wall motion score index was higher in LVMT than non-LVMT patients (0.88 +/- 1.79 versus 0.65 +/- 0.36, respectively; P=0.01), indicating worse cardiac systolic function. LVMT patients were treated with warfarin for 3-6 months. The incidence of death was similar between the groups (111.1% for LVMT patients versus 12.8% for non-LVMT patients, P=0.79) over a mean follow-up of 71-72 months. The only independent predictor found for LVMT occurrence was worse regional wall motion of the apex (odds ratio, 2.04, 95% confidence interval, 1.39-3.03; P < 0.001). Conclusions In the contemporary 'real-world scenario, despite aggressive reperfusion treatment and anti-aggregant use, the incidence of LVMT remained high after anterior ST-elevation AM I. LVMT was not related to increased intermediate-term mortality when patients were treated with warfarin, and the only predictor of LVMT occurrence was regional function of the apex.