Department of Cardiology, the Second Xiangya Hospital of Central South University, No.139, middle Ren-min road, Changsha, Hunan, 410011, China.
Department of Cardiology, the Second Xiangya Hospital of Central South University, No.139, middle Ren-min road, Changsha, Hunan, 410011, China.
Eur J Intern Med. 2020 Mar;73:43-50. doi: 10.1016/j.ejim.2019.10.029. Epub 2019 Nov 8.
The prognosis and management of left ventricular thrombus (LVT) following acute myocardial infarction (AMI) have not been well evaluated since the advent of primary percutaneous coronary intervention (PCI). We therefore conducted a meta-analysis to assess the prognostic effect of LVT after AMI in primary PCI era and investigate the impact of triple therapy on outcomes.
We searched MEDLINE, EMBASE and the Cochrane Library for studies conducted in primary PCI era up to 29 March 2019, compering the incidence of embolic events and mortality after AMI between LVT patients and Non-LVT patients. Random-effect models were used. Subgroup analysis was done by comparing triple therapy treated LVT group with Non-LVT group.
A total of 12 studies were included. LVT was associated with increased risk of embolic events and long-term mortality (RR 3.97, 95%CI 2.68-5.89, P < 0.0001; RR 2.34, 95%CI 1.38-3.96, P = 0.002). Subgroup analysis was also done by comparing triple therapy treated LVT group with Non-LVT group. Despite a downward tendency was observed, the embolic risk of triple therapy subgroup was higher than non-LVT group (RR 2.79, 95%CI 1.32-5.91, P = 0.007). Triple therapy subgroup had a similar mortality rate compared with non-LVT group (RR 0.93, 95%CI 0.34-2.52, P = 0.88).
In primary PCI era, LVT formation after AMI indicated a fourfold increased embolic risk and twofold long-term mortality rate. Triple therapy may be a safe way to improve the outcomes, but still need to be confirmed by future trials.
自从直接经皮冠状动脉介入治疗（PCI）出现以来，对于急性心肌梗死（AMI）后左心室血栓（LVT）的预后和处理尚未得到很好的评估。因此，我们进行了一项荟萃分析，以评估 AMI 后在直接 PCI 时代 LVT 的预后影响，并探讨三联疗法对结局的影响。
我们检索了 MEDLINE、EMBASE 和 Cochrane 图书馆，截至 2019 年 3 月 29 日，比较了 LVT 患者和非 LVT 患者在 AMI 后发生栓塞事件和死亡率的发生率。采用随机效应模型。通过比较三联疗法治疗的 LVT 组与非 LVT 组进行亚组分析。
共纳入 12 项研究。LVT 与栓塞事件和长期死亡率增加相关（RR 3.97，95%CI 2.68-5.89，P<0.0001；RR 2.34，95%CI 1.38-3.96，P=0.002）。通过比较三联疗法治疗的 LVT 组与非 LVT 组进行了亚组分析。尽管观察到下降趋势，但三联疗法亚组的栓塞风险仍高于非 LVT 组（RR 2.79，95%CI 1.32-5.91，P=0.007）。三联疗法亚组与非 LVT 组的死亡率相似（RR 0.93，95%CI 0.34-2.52，P=0.88）。
在直接 PCI 时代，AMI 后 LVT 的形成表明栓塞风险增加了四倍，长期死亡率增加了两倍。三联疗法可能是改善结局的一种安全方法，但仍需要未来的试验来证实。
