早期肝素化对急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗的疗效

目的 探究直接经皮冠状动脉介入术前(primary percutaneous coronary intervention, pPCI)肝素化对ST段抬高型心肌梗死（ST segment elevation myocardial infarction, STEMI）患者的影响。方法 连续入选STEMI患者117例,随机分为观察组和对照组,观察组确诊为STEMI后立即静脉注射普通肝素5 000 U,对照组于术中给予普通肝素5 000 U。观察肝素启动时间、PCI前活化的凝血时间(activated coagulation time, ACT)、心肌损伤标志物峰值、心肌微循环阻力指数(index of microcirculation resistance, IMR)、其他心肌灌注评估指标。记录术后主要不良事件（major adverse events, MAES）。结果 与对照组比较,观察组肝素给予的时间明显提前（约28 min）,术前ACT明显延长(P=0.000),血栓负荷率低（25.00% vs 43.90%, P=0.032）;造影即刻梗死相关动脉(IRA)的TIMI血流0~1级率低（45.00% vs 68.40%,P=0.011）,TIMI心肌灌注分级(TMPG) 3级率高（75.30% vs 56.10%,P=0.032）,IMR较低（P=0.007）,心肌损伤标志物CK MB峰值低（P=0.007）,心肌灌注缺损面积(perfusion defect area, PDA) 较低（P=0.031）。结论 pPCI术前早期肝素化提高了IRA的开通率,缩短心肌总缺血时间,缩小心肌梗死面积,改善心肌灌注,不增加MAES的风险。     

中性粒细胞与淋巴细胞比值对ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗后微循环障碍的预测价值

目的基于微循环阻力指数（IMR）探讨ST段抬高型心肌梗死（STEMI）患者中性粒细胞与淋巴细胞比值（NLR）和直接经皮冠状动脉介入治疗（PCI）术后微循环障碍的关系。 方法选择2016年1月至2018年12月期间苏北人民医院收治的50例急性STEMI患者为研究对象,将患者分为低NLR组（NLR ≤ 6.17,25例）和高NLR组（NLR > 6.17,25例）。比较两组患者的临床资料、冠状动脉病变情况、介入治疗方案及直接PCI术后IMR值,并采用Pearson相关分析NLR与直接PCI术后IMR的相关性。 结果低NLR组和高NLR组患者糖尿病病史（7/25 vs. 15/25,χ² = 5.195,P = 0.023）、高血脂病史（7/25 vs. 14/25,χ² = 4.023,P = 0.045）、中性粒细胞计数[6.33（4.04,6.66）× 10⁹/L vs. 7.90（7.23,12.09）× 10⁹/L,H = 18 716.000,P < 0.001]、淋巴细胞计数[1.85（1.37,2.56）× 10⁹/L vs. 0.87（0.78,1.03）× 10⁹/L,H = 29 710.000,P < 0.001]、发病-球囊扩张时间[227.00（180.00,390.00）min vs. 360.00（270.00,435.00）,H = 25 199.500,P < 0.001]及直接PCI术后IMR值[（29.9 ± 2.7）vs.（40.4 ± 1.7）,t = 16.307,P < 0.001]比较,差异均有统计学意义。Pearson相关分析显示,NLR与IMR具有正相关性（r = 0.676,P < 0.001）。进一步简单线性回归分析示,患者NLR与直接PCI术后微循环障碍的发生有关（R² = 0.457,P < 0.001）。 结论STEMI患者入院时,较高的NLR水平与直接PCI术后严重的微循环障碍密切相关,对预测STEMI患者直接PCI术后微循环状态有一定的参考价值。     

直接经皮冠状动脉介入治疗的610例急性ST段抬高心肌梗死患者临床特征及治疗现状

目的：研究南京地区接受直接经皮冠状动脉介入治疗（PCI）的急性 ST 段抬高心肌梗死（STEMI）患者的基线特征及治疗现状。方法回顾性分析610例南京市鼓楼医院因STEMI行急诊PCI患者的临床资料。结果患者平均年龄（64.2±12.3）岁,发病后“症状-进门时间”中位数为180 min,“进门-球囊扩张时间”中位数为100 min。冠状动脉病变以多支病变居多,主要累及左前降支和右冠状动脉。住院期间药物使用率：阿司匹林、氯吡格雷应用率均为100%,低分子肝素/磺达肝癸钠为97.4%、调脂药为92.6%、β-受体阻滞剂为83.8%、血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂（ACEI/ARB）为82.2%。住院期间死亡率为3.6%,多因素分析表明年龄（OR＝1.05,P＝0.049）、室性心律失常（OR＝5.21,P＝0.007）、心源性休克（OR＝14.54,P＝0.000）及术后TIMI血流分级（OR＝0.28,P＝0.000）与住院期间死亡率有独立的联系。结论南京地区STEMI发病具有年轻化的特点,院前延迟率较高,住院药物治疗与国内外大型研究结果接近,但仍有较大的改善空间。     

Protective effects of anisodamine on renal function in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

ST-segment elevation myocardial infarction (STEMI) is the most severe type of heart attack, and primary percutaneous coronary intervention (PCI) is the first line treatment for STEMI. However, these patients are at higher risk of contrast-induced nephropathy (CIN), which increases the length of hospital stay and mortality rate. Anisodamine, an alkaloid extracted from a Chinese herb, has been shown to exert protective effects on the renal function. The aim of this study was to investigate the protective effect of anisodamine on CIN in STEMI patients undergoing primary PCI. A total of 126 consecutive STEMI patients were randomly assigned to receive anisodamine (n=60) or placebo (control, n=66) from admission to 24 hours after PCI. The serum creatinine (SCr) concentrations, estimated glomerular filtration rate (eGFR) and incidence of CIN were measured on admission, and 24, 48 and 72 hours after PCI between the two groups. We found that the renal function of all patients after PCI underwent a course from injury to recovery. The incidence of CIN was 5.0%, 8.3%, and 6.7% at 24, 48 and 72 hours, respectively, after primary PCI in anisodamine group, while in control group it was 16.7%, 22.7%, and 19.7%, respectively. The incidence of CIN in anisodamine group was lower than that in control group during 72 hours after PCI (all P<0.05). In conclusion, intravenous infusion of anisodamine before and after primary PCI may reduce the occurrence of CIN in STEMI patients undergoing primary PCI, without serious side effects.     

择期经皮冠状动脉介入治疗对心肌梗死患者左室重构的影响

目的 :应用二维超声心动图对接受经皮冠状动脉介入治疗的心肌梗死患者术前、术后 6个月各指标进行观测 ,并与未行冠状动脉介入治疗的心肌梗死组比较 ,以探讨经皮冠状动脉介入治疗对心肌梗死患者左室重构的影响。方法 :将 2 7例接受经皮冠状动脉介入治疗的心肌梗死患者作为研究组 ,另取 2 9例未行经皮冠状动脉介入治疗的心肌梗死患者作为对照组 ;经皮冠状动脉介入治疗组分别于术前、术后 6个月完成各指标的测量 ,与对照组的二维超声各指标进行分析 ,以评估经皮冠状动脉介入治疗对左室重构的影响。结果 :两组心肌梗死患者术前二维超声心动图各指标无显著差异 ,经皮冠状动脉介入治疗组术后 6个月与对照组比较左室射血分数 ,短轴缩短率有不同程度改善 ,但尚无统计学意义 ,缩末容量、舒末容量较对照组显著降低 (P<0 .0 5 )。结论 :经皮冠状动脉介入治疗术可改善缺血 ,延缓心肌梗死后的心室重构 ,促进顿抑及冬眠心肌的恢复     

Relation of ischemia-modified albumin levels and left ventricular systolic function in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

BACKGROUND: Ischemia-modified albumin (IMA) has been shown to be elevated in patients after percutaneous coronary intervention (PCI). Our goal was to investigate the association between IMA levels and left ventricular ejection fraction in patients with ST-segment elevation myocardial infarction (STEMI) treated with PCI and who developed heart failure during their Coronary Care Unit (CCU) stay. METHODS: We assessed 75 patients with a first STEMI. Presence of heart failure was assessed during CCU admission, and patients were subdivided into 2 groups: group A (n=45) comprised patients in Killip class I, and group B (n=30) Killip classes>I. Serum IMA concentration was measured within the first 15 min post-PCI. The IMA measured was performed using an indirect method based in the Albumin Cobalt Binding (ACB) colorimetric assay. The ideal cutoff value of IMA was calculated by the receiver operating characteristic (ROC) curve analysis. RESULTS: Serum IMA concentrations were significantly higher in group B than in group A (0.37+/-0.09 vs 0.30+/-0.06 (A.U.); p<0.0001). The sensitivity and specificity of IMA for heart failure were 93.3% and 37.7%, respectively, at 0.31 A.U. Multivariable adjustment IMA showed a significant inverse correlation with left ventricular ejection function (r=-0.32; p=0.004). On multivariable analysis both IMA (OR=2.1, 95%CI: 1.2 to 3.9, p<0.001) and left ventricular ejection function (OR=1.7, 95%CI: 1.1 to 2.1, p<0.01) correlated with the occurrence of heart failure. CONCLUSION: In patients with STEMI undergoing PCI, serum IMA concentrations are significantly related to LVEF and represent an early marker of left ventricular dysfunction.     

Impact of white blood cell count on myocardial salvage,infarct size,and clinical outcomes in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: a magnetic resonance imaging study

We sought to determine the relationship between white blood cell count (WBCc) and infarct size assessed by cardiovascular magnetic resonance imaging (CMR) in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). In 198 patients undergoing primary PCI for STEMI, WBCc was measured upon arrival and CMR was performed a median of 7 days after the index event. Infarct size was measured on delayed enhancement imaging and the area at risk (AAR) was quantified on T2-weighted images. Baseline characteristics were not significantly different between the high WBCc group (>11,000/mm³, n = 91) and low WBCc group (≤11,000/mm³, n = 107). The median infarct size was larger in the high WBCc group than in the low WBCc group [22.0 % (16.7–33.9) vs. 14.7 % (8.5–24.7), p < 0.01]. Compared with the low WBCc group, the high WBCc group had a greater extent of AAR and a smaller myocardial salvage index [MSI = (AAR?infarct size)/AAR × 100]. The major adverse cardiovascular events (MACE) including cardiac death, nonfatal reinfarction, and rehospitalization for congestive heart failure at 12-month occurred more frequently in the high WBCc group (12.1 vs. 0.9 %, p < 0.01). In multivariate analysis, high WBCc significantly increased the risk of a large infarct (OR 3.04 95 % CI 1.65–5.61, p < 0.01), a low MSI (OR 2.08, 95 % CI 1.13–3.86, p = 0.02), and 1-year MACE (OR 16.0, 95 % CI 1.89–134.5, p = 0.01). In patients undergoing primary PCI for STEMI, an elevated baseline WBCc is associated with less salvaged myocardium, larger infarct size and poorer clinical outcomes.     

NT-proBNP对经急诊冠脉介入治疗的急性ST段抬高型心肌梗死患者预后的预测价值

目的探讨血浆N氨基末端脑钠肽前体(NT-proBNP)对行急诊经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死患者(STEMI)预后的预测价值。方法检测198例行急诊PCI的STEMI患者发病24 h时血浆NT-proBNP水平,根据中位数将患者平均分为高NT-proBNP组与低NT-proBNP组,每组99例。比较2组患者一般资料、随访1年时超声心动图结果及主要心脏不良事件(MACE)等情况,并分析STEMI后MACE发生率与血浆NT-proBNP的相关性。结果低NT-proBNP组平均年龄显著低于高NT-proBNP组,男性比例显著高于高NT-proBNP组。低NT-proBNP组超声心动图结果显著优于高NT-proBNP组,而MACE发生率显著低于高NT-proBNP组。血浆NT-proBNP是1年内急性心肌梗死后MACE的独立危险因素。结论早期检测血浆NT-proBNP水平对行急诊PCI的STEMI患者可能发生的MACE有预测价值。     

易化与直接经皮冠状动脉介入治疗ST段抬高型心肌梗死的对比研究

目的比较易化经皮冠状动脉介入 （facilitated percutaneous coronary intervention,FPCI） 与直接经皮冠状动脉介入（ primary percutaneous coronary intervention, PPCI） 治疗ST段抬高型心肌梗死（ ST-segment elevation myocardial in/arction,STEMI）患者的疗效及安全性。方法连续收集158倒首次STEMI患者,其中80例患者为基层卫生院给予静脉全量尿激酶溶栓联合经皮冠状动脉介入 （percutaneous coronary intervention,PCI） 治疗即FPCI组,78例患者为由基层卫生院直接转运行经皮冠状动脉介入治疗即PPCI组。观察两组患者梗死相关血管（infarction related artery,IRA） 再通情况及主要出血并发症,并分别于PCI术后第30天和第180天行心脏超声心动图检查,评价心功能改善情况,随访6个月,比较两组患者IRA再闭塞、心力衰竭、脑卒中及心源性猝死等的发生情况。结果首次冠状动脉造影显示FPCI组PCI术前心肌梗死试验性溶栓治疗（TIMI）3级血流率明显高于PPCI组（P=0．001）,术后TIMI3级血流率差异无统计学意义（P=0．762）;住院期问主要出血并发症FPCI组高于PPCI组,但差异无统计学意义（P=0．491）;两组患者术后30天、术后180天左心室射血分数比较差异均无统计学意义（P〉0．05）,分别为（51．3±4．2）％VS（50．7±5．2）％,（52．8±6．7）％VS（54．8±6．3）％。两组患者IRA再闭塞、心力衰竭、脑卒中及心源性猝死发生率比较差异无统计学意义（P〉0．05）。结论FPCI是安全有效的,对于基层卫生院首诊的STEMI患者,如果发病时间未超过2小时且转运时间可能超过3小时,可以先行溶栓后转运至三甲医院行PCI治疗。     

急诊冠状动脉介入治疗对急性心肌梗死患者脑钠肽水平的影响

目的 观察急诊冠状动脉介入治疗(PCI)对急性心肌梗死患者血浆脑钠肽(BNP)水平的影响,并进一步探讨其对左室重构的影响.方法 急性心肌梗死患者118例,其中PCI组52例,在发病后6～12 h内成功行急诊PCI;保守治疗组66例,为同期拒绝急诊PCI或急诊PCI失败者.两组均于入院即刻,12、24、48和72 h以及7、14和28 d测定血浆BNP浓度;采用多普勒超声诊断仪测量两组患者人院3～5 d和28 d的左室射血分数(LVEF).以同期20例健康体检者的检测值作为正常参考值.结果 两组患者入院即刻血浆BNP水平均高于正常健康者,同组不同时间点BNP浓度比较差异亦有统计学意义(P均＜0.01).保守治疗组血浆BNP水平呈双峰曲线,12～24 h达高峰,7 d时出现第二次峰值.PCI组血浆BNP水平呈单峰曲线,于12～24 h达到峰值.PCI组各时间点BNP水平均显著低于保守治疗组(P均＜0.01).两组患者3～5 d的LVEF值比较差异无统计学意义;28 d时PCI组LVEF值明显高于保守治疗组(P＜0.01).结论 急诊PCI能够降低急性心肌梗死患者血浆BNP水平,提高LVEF值,从而减轻左室重构.     

Effectiveness and cost-effectiveness of facilitated percutaneous coronary intervention compared with primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction transferred from community hospitals

BACKGROUND: Primary percutaneous coronary intervention ([PCI], percutaneous transluminal coronary angioplasty+stenting) for ST-segment elevation myocardial infarction (STEMI) is regarded as superior to fibrinolysis even if it means that patients need to be transferred from one center to another to undergo the procedure. However, this inevitable delay between symptom onset and PCI, caused by the time required to travel, might increase the occurrence of cardiac events. A hybrid method called facilitated PCI uses fibrinolysis and/or glycoprotein (GP) IIb/IIIa inhibitors before transfer to a tertiary medical center where urgent PCI might be performed. This approach, however, has not been systematically evaluated. OBJECTIVE: The purpose of this study was to compare the effectiveness (combined end point of in-hospital mortality, reinfarction, stroke, or emergency revascularization) and cost-effectiveness of utilizing a bolus thrombolytic agent with GP IIb/IIIa inhibitor followed by transfer to a tertiary institution for facilitated PCI or standard of care transfer without primary PCI drugs among patients presenting to a community hospital with STEMI. METHODS: This was a prospective, single-center, cohort study comprising data from STEMI patients transferred from community hospitals to Hartford Hospital, Hartford, Connecticut, from the years 2000 to 2003. At the time of analysis, patients receiving primary PCI were matched (1:1) with those receiving facilitated PCI, utilizing propensity scores to assure similar demographics. The combined incidence of major adverse cardiac end points (MACE) and total hospital costs was compared between groups. Non-parametric bootstrapping was conducted to calculate CIs for the incremental cost-effectiveness ratio and generate a quadrant analysis. RESULTS: Based on 254 propensity score-matched patients (127 facilitated PCI and 127 primary PCI), in-hospital MACE and total hospital costs were reduced by 61.3% and US 4563 dollars (2005), respectively, in patients receiving facilitated compared with primary PCI (P=0.021 and P=NS, respectively). Patients receiving facilitated PCI were more likely to have target lesion Thrombolysis in Myocardial Infarction (TIMI) III (normal) blood flow on cardiac catheterization than those receiving primary PCI (49.6% vs 30.7%; P=0.002). However, the rate of TIMI bleeding was similar in both groups (21.3% in the facilitated PCI group vs 18.9% in the primary PCI group). Nonsignificant reductions were observed in both intensive care unit (ICU) and total length of stay (LOS) (0.8 day and 1.0 day, respectively) compared with the primary PCI group. Bootstrap analysis revealed that of 25,000 samplings, facilitated PCI would likely be both more effective and less costly 94.6% of the time. CONCLUSIONS: The use of facilitated PCI in STEMI patients who initially presented to community hospitals and were transferred for PCI appeared to significantly reduce the incidence of MACE, and increase the likelihood of having baseline TIMI III blood flow at time of catheterization. Nonsignificant reductions were observed in total ICU and hospital LOS. However, there did not appear to be a significant effect on the incidence of bleeding in patients receiving facilitated PCI. Bootstrap analysis confirmed that facilitated PCI would be both a more effective and less costly strategy.     

替罗非班对急诊介入治疗急性心肌梗死患者内皮细胞功能的影响

目的：分析冠状动脉介入治疗急性ST段抬高型心肌梗死中应用替罗非班对内皮细胞功能的影响。方法：冠状动脉介入治疗的急性ST段抬高型心肌梗死患者140例，随机分为替罗非班组和对照组，每组各70例，替罗非班组给予冠状动脉内或静脉注射负荷剂量后静脉滴注替罗非班。分别检测各组围术期血清一氧化氮和血管性血友病因子含量黏附分子；比较两组患者近期临床疗效。结果：与对照组比较，替罗非班组血管性血友病因子、血浆组织因子水平显著降低（P〈0．05），内皮细胞凋亡数明显减少（P〈0．05），可溶性细胞间黏附分子浓度降低（P〈0．05）。替罗非班组术后住院期间难治性心绞痛、心肌再梗死及心力衰竭、30d心肌再梗死及心力衰竭发生率降低（P〈0．05）。结论：替罗非班在急性心肌梗死急诊冠状动脉介入治疗中可保护冠状动脉内皮细胞功能，提高近期临床疗效。     

经皮直接冠状动脉介入治疗急性ST段抬高性心肌梗死术后迟发性心脏压塞

目的 总结直接经皮冠状动脉介入治疗术(PPCI)治疗急性ST段抬高性心肌梗死(STEMI)后迟发性心脏压塞的临床特点、早期诊断、早期处理和救治结果.方法 分析解放军第306医院自2011年8月至2014年3月共503例STEMI行PPCI后并发迟发性心脏压塞3例(0.6％)的临床表现及诊疗经过.结果 3例迟发性心脏压塞发生在STEMI后18 ～54 h内,PPCI术后14～46 h.梗死部位均为前壁,靶血管均为前降支.其中2例首发症状为血压突然降低,1例表现为与呼吸有关的胸痛,并可闻及心包摩擦音.3例均在床旁超声引导下经心包穿刺引流,并保留引流管2～3d,均痊愈出院.结论 PPCI治疗STEMI后迟发性心脏压塞最易发生在术后3d内,故需强化早期识别此类患者的临床表现,而急诊床旁心脏超声检查是快速诊断的关键,及时行心包穿刺引流,可改善预后.     

尼可地尔对急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后的临床效果观察

目的探讨尼可地尔治疗急性ST段抬高型心肌梗死的效果。方法选取2018年5月至2019年5月山西医科大学附属运城医院心内科收治的121例急性前壁ST段抬高型心肌梗死并接受急诊经皮冠状动脉介入(PCI)治疗的患者,男101例,女20例,年龄(61.35±3.93)岁,年龄范围为46~77岁,采用随机数表法将其随机分为常规用药组(n=61)与尼可地尔组(n=60)。常规用药组患者接受冠状动脉粥样硬化性心脏病二级预防用药,尼可地尔组在常规用药组的基础上术前经冠状动脉注射尼可地尔4 mg,术后口服尼可地尔5 mg,每日3次,持续6个月,观察两组患者介入术中慢血流和无复流的发生情况、心肌梗死溶栓试验(TIMI)血流分级、血清心肌超敏肌钙蛋白T水平及术后住院期间心力衰竭和心律失常的发生情况,观察两组患者术后6个月心脏事件的发生情况(包括再发心肌梗死、充血性心力衰竭、再住院、全因死亡),记录治疗期间两组患者心绞痛发生情况,持续治疗6个月,评价并比较两组患者临床治疗效果。结果行急诊PCI术后24 h,尼可地尔组超敏肌钙蛋白T水平[(4407±809)pg/ml]低于常规用药组[(7456±1028)pg/ml],差异有统计学意义(P<0.05)。尼可地尔组心力衰竭的发生率[6.6%(4/61)]低于常规用药组[20.0%(12/60)],心律失常的发生率[9.8%(6/61)]低于常规用药组[23.3%(14/60)],差异有统计学意义(P<0.05)。尼可地尔组患者心绞痛复发率[6.6%(4/61)]低于常规用药组[23.3%(14/60)],差异有统计学意义(P<0.05)。结论持续尼可地尔治疗可以降低急性ST段抬高型心肌梗死患者心肌损伤,改善急性ST段抬高型心肌梗死的短期治疗效果,改善患者长期的心功能,值得在临床上推广应用。     

左心室整体纵向应变预测急性心肌梗死患者经皮冠状动脉介入术后左心室重构

目的 探讨应用二维斑点追踪(STE)技术预测急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)术后左心室重构(LVR)的价值。方法 对75例AMI患者于PCI术后72 h及6个月行STE检查,测算左心室整体圆周应变(GCS)及整体纵向应变(GLS)。以术后6个月左心室舒张末期容积(LVEDV)≥15%作为LVR诊断标准。进行统计学分析。结果 PCI术后6个月,75例中56例未发生重构(非重构组),19例发生LVR(重构组),发生率25.33%(19/75)。与术后72 h比较,重构组术后6个月LVEF减低,非重构组术后6个月LVEF增高(P均<0.05)。与非重构组比较,重构组术后72 h及术后6个月GCS及GLS均减低(P均<0.05)。LVEF、GCS及GLS均与LVR呈负相关(r=-0.39、-0.52、-0.64,P均<0.01)。GLS及GCS是LVR的独立预测因子。GLS的ROC曲线下面积最大,预测LVR的阈值为-12.45%,敏感度和特异度分别为86.3%及87.2%。STE参数测量观察者间差异为(9.32±3.14)%,观察者内差异为(7.18±2.26)%。结论 通过STE测得的GLS可用以准确预测AMI患者PCI术后LVR。     

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

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.