Robinson Austin A, Jain Amit, Gentry Mark, McNamara Robert L
Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States.
Mayo Clinic, Rochester, MN, United States.
Int J Cardiol. 2016 Oct 15;221:554-9. doi: 10.1016/j.ijcard.2016.07.069. Epub 2016 Jul 6.
Left ventricular (LV) thrombus formation following myocardial infarction (MI) has not been well characterized since the advent of primary percutaneous coronary intervention (pPCI). Ascertainment of the utility of prophylactic anticoagulation is hindered by the lack of reliable information on its modern incidence. We sought to provide an estimate of the rate of LV thrombus formation in patients treated with pPCI for ST segment elevation MI (STEMI) by means of a systematic review and meta-analysis.
We searched Ovid MEDLINE and Ovid EMBASE databases for studies between 1990 and 2015 documenting LV thrombi after STEMI treated with pPCI. We estimated the rate of echocardiographically-diagnosed LV thrombi within 90days of pPCI, calculating the rate of LV thrombi after STEMI in any infarct territory as well as only anterior infarcts.
From an initial yield of 1144 studies, inclusion criteria were met by 19 studies, including 10,076 patients across 27 centers in 9 countries. Rate of LV thrombi after all STEMI was 2.7% (95% CI 1.9%-3.5%) and 9.1% (95% CI 6.6%-11.6%) after anterior STEMI. Among anterior STEMI, there was an inverse relationship between size of study and rate of LV thrombi.
LV thrombi persist as an important part of the management of STEMI after pPCI, particularly among anterior infarcts. Estimating risk of thrombus formation and embolization as well as utility of treatment remains critical.
自直接经皮冠状动脉介入治疗（pPCI）出现以来，心肌梗死（MI）后左心室（LV）血栓形成的特征尚未得到充分描述。由于缺乏关于其现代发病率的可靠信息，预防性抗凝治疗效用的确定受到阻碍。我们试图通过系统评价和荟萃分析，对接受pPCI治疗的ST段抬高型心肌梗死（STEMI）患者的LV血栓形成率进行估计。
我们检索了Ovid MEDLINE和Ovid EMBASE数据库，以查找1990年至2015年间记录pPCI治疗STEMI后LV血栓的研究。我们估计了pPCI后90天内超声心动图诊断的LV血栓形成率，计算了STEMI后任何梗死区域以及仅前壁梗死的LV血栓形成率。
从最初检索到的1144项研究中，19项研究符合纳入标准，包括来自9个国家27个中心的10076例患者。所有STEMI后LV血栓形成率为2.7%（95%CI 1.9%-3.5%），前壁STEMI后为9.1%（95%CI 6.6%-11.6%）。在前壁STEMI中，研究规模与LV血栓形成率呈负相关。
LV血栓仍然是pPCI治疗STEMI后管理的重要组成部分，尤其是在前壁梗死患者中。估计血栓形成和栓塞的风险以及治疗的效用仍然至关重要。
