SPC365

Development of a Clinical Risk Score for Early Left Ventricular Thrombus Prediction Following Anterior ST-Segment Elevation Myocardial Infarction

Session: Sessão de Posters 36 - Antiagregação plaquetar
Speaker: Vanda Neto

Congress: CPC 2024
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.4 Acute Coronary Syndromes – Treatment
Session Type: Cartazes
FP Number: ---
Authors: Vanda Devesa Neto; Mariana Almeida; João Fiúza; Gonçalo Ferreira; Nuno Craveiro; Inês Pires; Joana Correia; António Costa

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="color:#0e101a">Introduction:</span></strong><span style="color:#0e101a">&nbsp;Despite improvements&nbsp;in the management of ST-segment elevation myocardial infarction (STEMI), the risk of left ventricular thrombus (LVT) remains a significant concern due to its potential for embolic complications. Early identification of patients at high risk for LVT is crucial for guiding therapeutic interventions and improving clinical outcomes. </span><span style="color:#0e101a">This study aimed to develop a practical and clinically applicable risk score that integrates readily available demographic, clinical, and echocardiographic parameters to predict the likelihood of early LVT formation post anterior STEMI.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="color:#0e101a">Methods:</span></strong><span style="color:#0e101a">&nbsp;A single-center study was performed including all patients admitted due to anterior STEMI and performed echocardiography in the days following the event. The newly designed score was calculated for each patient (0-15 points), after identification of the variables significantly associated with LVT formation (points attributed for each variable according to odds ratio). The score incorporates age, clinical presentation (Killip-Kimball classification), history of previous myocardial infarction and atrial fibrillation, and echocardiographic findings (left ventricular ejection fraction and apical aneurysm). ROC curve analysis was performed to evaluate the predictive value of the score.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="color:#0e101a">Results:</span></strong><span style="color:#0e101a">&nbsp;68 patients; mean age was 66.1&plusmn;13.5;&nbsp;81% male. History of previous myocardial infarction&nbsp;in 16% and 6%&nbsp;had atrial fibrillation. Killip-Kimball (KK) classification at admission was 57% in class I, 32% in&nbsp;class II, 2% in class III, and 9% in class IV.&nbsp;Fibrinolysis was performed in 27% of patients. Mean door-to-balloon time was 138.9&plusmn;123.4&nbsp;minutes. 13% presented &gt;12h after symptom onset. Successful reperfusion (Grade 3 in TIMI classification)&nbsp;in 84% of patients. Median LVEF was 41.2&plusmn;8.6%; apical aneurism&nbsp;in 34%. Contrast echocardiography was performed in 56% of patients. Apical thrombus was identified in 19%.&nbsp;&nbsp;</span></span></span><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif">&nbsp;</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#0e101a">The developed risk score demonstrated a clear association with thrombus formation (13%&nbsp;high-risk,&nbsp;4% intermediate-risk&nbsp;and 1.5% low-risk group; p&lt;0.01, &chi;2=17.02). ROC curve analysis revealed that the score had a robust predictive performance for early thrombus detection (AUC 0.82; p&lt;0.01, 95% CI 0.68-0.95).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#0e101a">High-risk classification had a significant association with apical aneurism (p&lt;0.01; &chi;2=11.88), previous acute myocardial infarction (p=0.02; x2 7.87), history of chronic pulmonary disease (p=0.01; &chi;2=9.07) and higher KK score (p&lt;0.01; &chi;2=17.24). No differences between groups regarding 6 months (p=0.24) and 12 (p=0.30) months mortality and 12 months hospital re-admission (p=0.68).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="color:#0e101a">Conclusion:</span></strong><span style="color:#0e101a">&nbsp;These findings suggest that the proposed risk score effectively stratifies patients based on their risk of developing LVT&nbsp;following anterior STEMI and could be used in daily practice to determine which patients should be aggressively investigated.&nbsp;</span></span></span></p>