Rabbani LeRoy Elazar, Waksmonski Carol, Iqbal Sohah N, Stant Jennifer, Sciacca Robert, Apfelbaum Mark, Sayan Osman R, Giglio James, Homma Shunichi
Division of Cardiology, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA.
J Thromb Thrombolysis. 2008 Apr;25(2):141-5. doi: 10.1007/s11239-007-0064-2. Epub 2007 Jun 12.
Previous studies have reported that left ventricular (LV) thrombus is a complication in 10-56% of ST-segment elevation acute anterior wall myocardial infarctions (AWMI). Data suggest that changes in acute myocardial infarction management such as early anticoagulation, thrombolysis, and most recently, primary percutaneous coronary intervention (PCI), may decrease thrombus occurrence. Early time to reperfusion has been shown to decrease mortality and improve LV function recovery. To determine if door-to-balloon time (DTBT) affects the incidence of LV thrombus, we retrospectively analyzed data on 43 consecutive patients who underwent successful PCI of a primary acute ST-segment elevation AWMI. Transthoracic echocardiography was performed for detecting LV thrombus and measuring LV ejection fraction (EF) within 5 days on all patients (average time: 2.17 days post event). Nineteen patients underwent PCI within 2 h of arrival to the Emergency Department (Group A, average 88 min) and 24 patients underwent PCI with DTBT of more than 2 h (Group B, average 193 min). Clinically significant LV thrombus was detected in 35% of all patients. The incidence of LV thrombus formation in Group A was not significantly different from that in Group B (42.1% vs. 29.0%, respectively; P = 0.52). The risk of LV thrombus was independent of in-hospital anticoagulation and medical management, peak enzyme levels, and LVEF but did relate to age (odds ratio = 1.96, 95% CI 1.03-3.73, P = 0.04 per decade). No embolic events in hospital were observed (average hospital stay 9.2 days). We conclude that the incidence of LV thrombus remains high despite PCI. Also, we find that DTBT in patients presenting with an ST-segment elevation AWMI does not affect the incidence of LV thrombus formation. Increased age, however, does appear to increase the risk of LV thrombus development.
既往研究报道，左心室（LV）血栓是10% - 56%的ST段抬高型急性前壁心肌梗死（AWMI）的并发症。数据表明，急性心肌梗死治疗方式的改变，如早期抗凝、溶栓，以及最近的直接经皮冠状动脉介入治疗（PCI），可能会降低血栓的发生率。早期再灌注已被证明可降低死亡率并改善左心室功能恢复。为了确定门球时间（DTBT）是否影响左心室血栓的发生率，我们回顾性分析了43例连续成功接受原发性急性ST段抬高型AWMI PCI治疗患者的数据。对所有患者在5天内进行经胸超声心动图检查以检测左心室血栓并测量左心室射血分数（EF）（平均时间：事件发生后2.17天）。19例患者在到达急诊科后2小时内接受了PCI治疗（A组，平均88分钟），24例患者的DTBT超过2小时接受了PCI治疗（B组，平均193分钟）。在所有患者中，35%检测到具有临床意义的左心室血栓。A组左心室血栓形成的发生率与B组无显著差异（分别为42.1%和29.0%；P = 0.52）。左心室血栓的风险与住院期间的抗凝和药物治疗、酶峰值水平及左心室射血分数无关，但与年龄有关（优势比 = 1.96，95%可信区间1.03 - 3.73，每增加十岁P = 0.04）。住院期间未观察到栓塞事件（平均住院时间9.2天）。我们得出结论，尽管进行了PCI治疗，但左心室血栓的发生率仍然很高。此外，我们发现ST段抬高型AWMI患者的DTBT不影响左心室血栓形成的发生率。然而，年龄增加似乎确实会增加左心室血栓形成的风险。
