Risk factors analysis in patients with early left ventricular thrombus post acute ST-segment elevation myocardial infarction in primary PCI mode / 中华急诊医学杂志

ABSTRACT

Objective:To investigate the risk factors of ST-segment elevation myocardial infarction (STEMI) with early left ventricular thrombus (LVT) under emergency percutaneous coronary intervention(PCI)mode.Methods:The clinical data were collected from 784 patients with STEMI treated with emergency percutaneous coronary intervention (pPCI) in our hospital from January 2014 to April 2019 . The observation indexes included baseline data, coronary angiography, disease course, laboratory examination and auxiliary examination. Patients with severe organic heart disease and having previous history of LVA and LVT were excluded. Totally 38 patients with LVT were selected as the experimental group and 114 patients with non-LVT selected as the control group according to the principle of age (the smallest absolute age difference between the experimental group and the control group) and sex. Data was analyzed by software Graphpad Prism5, SPSS 22.0 and Medcalc software were used for statistical analysis, and the Logistic regression model was established. A P<0.05 was considered statistically significant, and the risk factors of early LVT formation were retrospectively analyzed. Results:There was a linear relationship between the prolongation of TIT and the occurrence of LVT ( χ2= 304, P<0.01), and the Spearman relation was highly positive ( ρ=0.626, P<0.01). Multivariate conditional logistic regression analysis showed that prolonged TIT (total ischemic time), increased total amplitude of ST elevation, TIMI blood flow ≤ grade 2 after pPCI, decreased LVEF and LVA were independent risk factors for LVT, and their odds ratios ( OR) were 1.996, 13.689, 16.996, 0.868 and 9.195, respectively. Model 1 was constructed as LVA and the total amplitude of elevation of ST segments, and the receiver operating characteristic (ROC) was drawn, and the area under the ROC curve (AUC) was calculated as 0.889. Model 2 was obtained by adding TIT, LVEF and postoperative TIMI blood flow≤2, and the AUC was 0.990. Delong method was used to compare the AUC values between the two groups, and there was a statistical difference ( Z=3.294, P=0.001). Conclusions:The risk factors of STEMI complicated with early LVT under "emergency PCI mode" may have changed. Clinicians should conduct early screening of high-risk people factors of LVT in order to reduce its incidence and improve the prognosis. It may be helpful to actively carry out emergency bedside echocardiography before operation.