Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis
Abstract Introduction The incidence of left ventricular (LV) thrombus formation in ST-segment elevation myocardial infarction (STEMI) patients in the current era of primary percutaneous coronary intervention (PCI) is not well established. We performed a meta-analysis to assess the actual incidence a...
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doaj-2c83526210a44112a124174d0cc223ce2020-11-25T01:27:32ZengBMCJournal of Cardiovascular Magnetic Resonance1532-429X2018-11-0120111010.1186/s12968-018-0494-3Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysisHeerajnarain Bulluck0Mervyn H. H. Chan1Valeria Paradies2Robert L. Yellon3He H. Ho4Mark Y. Chan5Calvin W. L. Chin6Jack W. Tan7Derek J. Hausenloy8Norfolk and Norwich University HospitalNational Heart Research Institute Singapore, National Heart Centre SingaporeNational Heart Research Institute Singapore, National Heart Centre SingaporeThe Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College LondonDepartment of Cardiology, Tan Tock Seng HospitalDepartment of Cardiology, National University HospitalNational Heart Centre SingaporeNational Heart Centre SingaporeThe Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College LondonAbstract Introduction The incidence of left ventricular (LV) thrombus formation in ST-segment elevation myocardial infarction (STEMI) patients in the current era of primary percutaneous coronary intervention (PCI) is not well established. We performed a meta-analysis to assess the actual incidence and predictors of LV thrombus by cardiovascular magnetic resonance (CMR) in STEMI treated by primary PCI. Methods We searched MEDLINE and EMBASE databases up to February 2018. We included all studies published as a full-text article, reporting the incidence of LV thrombus by CMR within 1 month following acute STEMI in patients treated by primary PCI. A binary random-effects model was used to estimate the pooled incidence of LV thrombus. The diagnostic performance of transthoracic echocardiography (TTE) as compared with CMR was pooled to obtain the sensitivity and specificity of TTE with CMR as the gold standard. Embolic and bleeding complications of LV thrombus were also evaluated. Results Ten studies were included in the meta-analysis. The incidence of LV thrombus by CMR in all-comer STEMI patients (n = 2072) was 6.3% with 96% of LV thrombus occurring in those with anterior STEMI (12.2% incidence). When only anterior STEMI with LVEF< 50% were considered (n = 447), the incidence of LV thrombus was 19.2%. Compared with CMR, the sensitivity of TTE to detect LV thrombus was 29% with a specificity of 98%. The sensitivity of TTE increased to 70% in those with anterior STEMI and reduced LVEF. LV thrombus resolved in 88% of cases by 3 to 6 months. After 1–2 years follow-up, the embolic complication rate was similar at 1.5% (P = 0.25) but the bleeding complication rate was significantly higher (8.8% versus 0.5%, P < 0.001) in the LV thrombus group on triple therapy when compared to the no LV thrombus group on dual antiplatelet therapy. Conclusion In the primary PCI era, CMR detection of an LV thrombus post-STEMI remains high with incidence of nearly 20% in anterior STEMI with depressed LVEF. Patients with LV thrombus treated by triple therapy had similar embolic complications but higher bleeding complications than those with no LV thrombus treated with dual antiplatelet therapy. A 3 month follow-up CMR scan to guide anticoagulation duration might help mitigate bleeding risk.http://link.springer.com/article/10.1186/s12968-018-0494-3Left ventricular thrombusST-segment elevation myocardial infarctionCardiovascular magnetic resonancePrimary percutaneous coronary intervention |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Heerajnarain Bulluck Mervyn H. H. Chan Valeria Paradies Robert L. Yellon He H. Ho Mark Y. Chan Calvin W. L. Chin Jack W. Tan Derek J. Hausenloy |
spellingShingle |
Heerajnarain Bulluck Mervyn H. H. Chan Valeria Paradies Robert L. Yellon He H. Ho Mark Y. Chan Calvin W. L. Chin Jack W. Tan Derek J. Hausenloy Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis Journal of Cardiovascular Magnetic Resonance Left ventricular thrombus ST-segment elevation myocardial infarction Cardiovascular magnetic resonance Primary percutaneous coronary intervention |
author_facet |
Heerajnarain Bulluck Mervyn H. H. Chan Valeria Paradies Robert L. Yellon He H. Ho Mark Y. Chan Calvin W. L. Chin Jack W. Tan Derek J. Hausenloy |
author_sort |
Heerajnarain Bulluck |
title |
Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis |
title_short |
Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis |
title_full |
Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis |
title_fullStr |
Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis |
title_full_unstemmed |
Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis |
title_sort |
incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute st-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis |
publisher |
BMC |
series |
Journal of Cardiovascular Magnetic Resonance |
issn |
1532-429X |
publishDate |
2018-11-01 |
description |
Abstract Introduction The incidence of left ventricular (LV) thrombus formation in ST-segment elevation myocardial infarction (STEMI) patients in the current era of primary percutaneous coronary intervention (PCI) is not well established. We performed a meta-analysis to assess the actual incidence and predictors of LV thrombus by cardiovascular magnetic resonance (CMR) in STEMI treated by primary PCI. Methods We searched MEDLINE and EMBASE databases up to February 2018. We included all studies published as a full-text article, reporting the incidence of LV thrombus by CMR within 1 month following acute STEMI in patients treated by primary PCI. A binary random-effects model was used to estimate the pooled incidence of LV thrombus. The diagnostic performance of transthoracic echocardiography (TTE) as compared with CMR was pooled to obtain the sensitivity and specificity of TTE with CMR as the gold standard. Embolic and bleeding complications of LV thrombus were also evaluated. Results Ten studies were included in the meta-analysis. The incidence of LV thrombus by CMR in all-comer STEMI patients (n = 2072) was 6.3% with 96% of LV thrombus occurring in those with anterior STEMI (12.2% incidence). When only anterior STEMI with LVEF< 50% were considered (n = 447), the incidence of LV thrombus was 19.2%. Compared with CMR, the sensitivity of TTE to detect LV thrombus was 29% with a specificity of 98%. The sensitivity of TTE increased to 70% in those with anterior STEMI and reduced LVEF. LV thrombus resolved in 88% of cases by 3 to 6 months. After 1–2 years follow-up, the embolic complication rate was similar at 1.5% (P = 0.25) but the bleeding complication rate was significantly higher (8.8% versus 0.5%, P < 0.001) in the LV thrombus group on triple therapy when compared to the no LV thrombus group on dual antiplatelet therapy. Conclusion In the primary PCI era, CMR detection of an LV thrombus post-STEMI remains high with incidence of nearly 20% in anterior STEMI with depressed LVEF. Patients with LV thrombus treated by triple therapy had similar embolic complications but higher bleeding complications than those with no LV thrombus treated with dual antiplatelet therapy. A 3 month follow-up CMR scan to guide anticoagulation duration might help mitigate bleeding risk. |
topic |
Left ventricular thrombus ST-segment elevation myocardial infarction Cardiovascular magnetic resonance Primary percutaneous coronary intervention |
url |
http://link.springer.com/article/10.1186/s12968-018-0494-3 |
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