Meng Wang, Mengwan Li, Wenheng Liu, Jian Li, Dan Chen, Ziqing Wang, Qilong Guo, Shouling Mi, Junhua Ge
{"title":"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。","authors":"Meng Wang, Mengwan Li, Wenheng Liu, Jian Li, Dan Chen, Ziqing Wang, Qilong Guo, Shouling Mi, Junhua Ge","doi":"10.31083/RCM28222","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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, <i>p</i> = 0.003), larger left ventricular aneurysm (LVA) area (>4.5 cm<sup>2</sup>, HR 4.038, <i>p</i> < 0.001), and greater mural thrombus (MT) area (>2.2 cm<sup>2</sup>, HR 2.40, <i>p</i> = 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%, <i>p</i> = 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%, <i>p</i> = 0.003), including stroke (<i>p</i> = 0.025) and systemic embolism (<i>p</i> = 0.034).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"28222"},"PeriodicalIF":1.9000,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135672/pdf/","citationCount":"0","resultStr":"{\"title\":\"Independent Risk Factors of Non-Resolution Mural Thrombus in ST-Segment Elevation Myocardial Infarction Patients with Left Ventricular Aneurysms.\",\"authors\":\"Meng Wang, Mengwan Li, Wenheng Liu, Jian Li, Dan Chen, Ziqing Wang, Qilong Guo, Shouling Mi, Junhua Ge\",\"doi\":\"10.31083/RCM28222\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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, <i>p</i> = 0.003), larger left ventricular aneurysm (LVA) area (>4.5 cm<sup>2</sup>, HR 4.038, <i>p</i> < 0.001), and greater mural thrombus (MT) area (>2.2 cm<sup>2</sup>, HR 2.40, <i>p</i> = 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%, <i>p</i> = 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%, <i>p</i> = 0.003), including stroke (<i>p</i> = 0.025) and systemic embolism (<i>p</i> = 0.034).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":20989,\"journal\":{\"name\":\"Reviews in cardiovascular medicine\",\"volume\":\"26 5\",\"pages\":\"28222\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-05-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135672/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Reviews in cardiovascular medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.31083/RCM28222\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/5/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Reviews in cardiovascular medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.31083/RCM28222","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Independent Risk Factors of Non-Resolution Mural Thrombus in ST-Segment Elevation Myocardial Infarction Patients with Left Ventricular Aneurysms.
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.
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.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
