Analysis Of Risk Factors Of Left Ventricular Thrombosis After Percutaneous Coronary Intervention In Patients With Acute ST Segment Elevation Myocardial Infarction

Objective:To investigate the incidence of left ventricular thrombosis after percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction and to explore the independent risk factors of left ventricular thrombosis by multivariate analysis.Methods:The discharge date of Guilin people’s Hospital was from January1,2018 to May 31,2022,and the discharge was diagnosed as "acute ST segment elevation myocardial infarction"(STEMI).Patients aged 18 to 90 years old who received percutaneous coronary intervention(PCI)and completed echocardiography were divided into LVT group and non-LVT group according to whether they were complicated with left ventricular thrombus(LVT).The general clinical data,echocardiographic results,blood test indexes and data related to PCI treatment were collected and compared between the two groups.The factors affecting left ventricular thrombosis were analyzed by multivariate statistical analysis.ROC curve was used to analyze the best critical point of independent risk factors for LVT formation and the curative effect of diagnosis.Results: A total of 2147 patients who underwent LVT due to acute STEMI were included in this study.53 patients were complicated with LVT as the LVT group.The incidence of PCI was 2.5%,all of which were distributed in the apical part of the left ventricle.A total of 159 patients without LVT were randomly selected as non-LVT group.Compared with the non-LVT group,the proportion of male patients in the LVT group was higher,the history of smoking and alcohol abuse was more,and the average heart rate in the LVT group was higher than that in the non-LVT group.The average value of LVEF in LVT group was significantly lower than that in non-LVT group,while the proportion of patients with LVEF ≤ 40% and ventricular aneurysm formation in LVT group was significantly higher than that in non-LVT group(P < 0.001).The results of blood laboratory analysis showed that the average platelet volume,plasma D-dimer,homocysteine(HCY),urea nitrogen(BUN),uric acid,creatinine and high sensitivity troponin T(hs-c Tn T)in LVT group were significantly higher than those in non-LVT group.The proportion of patients undergoing direct LVT in LVT group was significantly lower than that in non-LVT group,and the rates of anterior descending artery disease and anterior wall myocardial infarction in PCI group were significantly higher than those in non-PCI group(P < 0.001).The time from symptom onset to the first balloon dilatation(SO-to-B)in the LVT group was longer than that in the non-LVT group(P < 0.001),but there was no significant difference in the time from entering the hospital gate to balloon dilatation between the two groups.After removing confounding factors,anterior wall myocardial infarction,direct PCI,SO-to-B time,ventricular aneurysm formation,smoking history,peak hs-c Tn T,BUN and HCY were independent influencing factors of left ventricular thrombosis after PCI in patients with acute STEMI.The odds ratio was 2.754,0.040,1.393,2.550,1.226,1.025,1.048,1.058,respectively.Using SO-to-B time = 200.0min as the critical value to predict left ventricular thrombosis had high sensitivity and specificity(0.781 and 0.741 respectively).Conclusion: The incidence of LVT detected by TTE within 3 months after PCI in acute STEMI after PCI treatment is significantly lower than that before PCI treatment.Anterior wall myocardial infarction,SO-to-B time,ventricular aneurysm,BUN,peak hs-c Tn T,HCY and smoking history were independent risk factors for left ventricular thrombosis after PCI in patients with acute STEMI,and direct PCI was an independent protective factor for the formation of LVT.Shortening the time of SO-to-B may help to reduce the incidence of left ventricular thrombosis after PCI in patients with acute STEMI.