Independent Risk Factors of Non-Resolution Mural Thrombus in ST-Segment Elevation Myocardial Infarction Patients with Left Ventricular Aneurysms.

IF 1.9 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Reviews in cardiovascular medicine Pub Date : 2025-05-08 eCollection Date: 2025-05-01 DOI:10.31083/RCM28222

Meng Wang, Mengwan Li, Wenheng Liu, Jian Li, Dan Chen, Ziqing Wang, Qilong Guo, Shouling Mi, Junhua Ge

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Abstract

Background: The clinical prognosis of ST-elevation myocardial infarction (STEMI) patients with mural thrombus in left ventricular aneurysm (MTLVA) remains poor; moreover, the risk factors associated with the non-resolution (persistent or recurrent) of MTLVA are not well understood. This study aimed to identify independent risk factors for MTLVA non-resolution.

Methods: A total of 133 STEMI patients (mean age 62 ± 11 years, 80.5% male) with MTLVA, admitted to our department between 2014 and 2022, were included in this retrospective analysis. Patients were categorized into two groups: resolution (n = 59) and non-resolution [persistent (n = 72) or recurrent (n = 2) MTLVA; n = 74]. The median follow-up duration was 25 months, during which adverse events were monitored, including stroke, re-revascularization, major bleeding, systemic embolism, and cardiac death.

Results: The prevalence of non-resolution was 55.6%. Non-resolution was significantly associated with elevated lipoprotein (a) [Lp(a)] levels (>270 mg/L, hazard ratios (HR) 2.270, p = 0.003), larger left ventricular aneurysm (LVA) area (>4.5 cm², HR 4.038, p < 0.001), and greater mural thrombus (MT) area (>2.2 cm², HR 2.40, p = 0.002), independent of other risk factors, such as hypercholesterolemia and left circumflex artery (LCX)-related STEMI. Baseline left ventricular ejection fraction (LVEF) was lower in the non-resolution group (41.7% vs. 45.7%, p = 0.008). During follow-up, the LVEF remained lower in the non-resolution group and increased in the resolution group. The composite of adverse events was significantly higher in the non-resolution group (28.4% vs. 8.5%, p = 0.003), including stroke (p = 0.025) and systemic embolism (p = 0.034).

Conclusions: Independent risk factors for thrombus non-resolution in STEMI patients with MTLVA include elevated Lp(a), larger LVA and MT areas. These factors contribute to thrombus persistence and are associated with worse clinical outcomes. However, further studies are needed to assess targeted management strategies for high-risk patients.

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st段抬高型心肌梗死合并左心室动脉瘤患者未溶解附壁血栓的独立危险因素。

背景：st段抬高型心肌梗死（STEMI）合并左室动脉瘤壁上血栓（MTLVA）患者的临床预后仍然较差；此外，与MTLVA不消退（持续性或复发性）相关的危险因素尚不清楚。本研究旨在确定MTLVA不解决的独立危险因素。方法：回顾性分析2014 - 2022年我科收治的133例STEMI MTLVA患者（平均年龄62±11岁，男性80.5%）。患者分为两组：缓解（n = 59）和非缓解[持续性（n = 72）或复发性（n = 2） MTLVA；N = 74]。中位随访时间为25个月，在此期间监测不良事件，包括中风、再血运重建、大出血、全身性栓塞和心脏性死亡。结果：未解决率为55.6%。非分辨率与脂蛋白(a) [Lp(a)]水平升高（>270 mg/L，危险比（HR） 2.270, p = 0.003）、较大的左室动脉瘤（LVA）面积（>4.5 cm2，危险比4.038,p < 0.001）和较大的壁栓（MT）面积（>2.2 cm2，危险比2.40,p = 0.002）显著相关，独立于其他危险因素，如高胆固醇血症和左旋动脉（LCX）相关STEMI。基线左室射血分数（LVEF）在非消退组较低（41.7%比45.7%,p = 0.008）。随访期间，非解决组LVEF保持较低，解决组LVEF升高。非缓解组不良事件的综合发生率显著高于对照组（28.4% vs. 8.5%, p = 0.003），包括卒中（p = 0.025）和全身栓塞（p = 0.034）。结论：STEMI合并MTLVA患者血栓不溶解的独立危险因素包括Lp(a)升高、LVA和MT面积增大。这些因素导致血栓持续存在，并与较差的临床结果相关。然而，需要进一步的研究来评估高危患者的针对性管理策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Reviews in cardiovascular medicine 医学-心血管系统

CiteScore

2.70

自引率

3.70%

发文量

377

审稿时长

1 months

期刊介绍： RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.