| Left ventricular mural thrombus after anterior ST-segment-elevation acute myocardial infarction in the era of aggressive reperfusion therapy--still a frequent complication. | |
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MedLine Citation:
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PMID: 16000884 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 (11.1% 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 AMI. 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. |
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Authors:
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Avital Porter; Hadas Kandalker; Zaza Iakobishvili; Alexander Sagie; Shula Imbar; Alexander Battler; David Hasdai |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Coronary artery disease Volume: 16 ISSN: 0954-6928 ISO Abbreviation: Coron. Artery Dis. Publication Date: 2005 Aug |
Date Detail:
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Created Date: 2005-07-07 Completed Date: 2006-07-14 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9011445 Medline TA: Coron Artery Dis Country: England |
Other Details:
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Languages: eng Pagination: 275-9 Citation Subset: IM |
Affiliation:
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Department of Cardiology, Rabin Medical Centre and Sackler Faculty of Medicine, Tel Aviv University, Israel. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Anticoagulants / therapeutic use Coronary Angiography Echocardiography, Doppler Electrocardiography Female Follow-Up Studies Heart Conduction System / physiopathology* Humans Logistic Models Male Middle Aged Myocardial Infarction / complications*, diagnosis, physiopathology, therapy* Myocardial Reperfusion* Platelet Aggregation Inhibitors / therapeutic use Predictive Value of Tests Research Design Retrospective Studies Survival Analysis Thrombosis / diagnosis, drug therapy, etiology*, physiopathology Ventricular Dysfunction, Left / diagnosis, etiology* |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Platelet Aggregation Inhibitors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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