# Impact of coronary revascularization on clinical outcomes of postacute myocardial infarction patients with left ventricular thrombus

## TL;DR

This study found that not undergoing coronary revascularization after a heart attack with left ventricular thrombus is linked to higher mortality, but not to the resolution of the thrombus.

## Contribution

The study provides new evidence on the association between revascularization and outcomes in post-AMI patients with left ventricular thrombus.

## Key findings

- Lack of revascularization was associated with higher mortality in post-AMI LVT patients.
- Revascularization was not significantly associated with LVT resolution.
- Optimizing medical therapy is emphasized as a key treatment goal.

## Abstract

The incidence of left ventricular thrombus (LVT), a significant complication postacute myocardial infarction (AMI), has seen a decline in the percutaneous coronary intervention era. Patients may not undergo coronary revascularization due to medical contraindications or patient preference.

This study compared post-AMI LVT patients treated with or without revascularization.

This was a retrospective study of 263 consecutive post-AMI patients diagnosed with LVT from November 2012 to January 2021, retrieved from an echocardiography database. Patients were stratified by their revascularization status.

Mean (SD) follow-up duration was 2.1 ± 2.1 years. Most post-AMI LVT patients underwent revascularization via percutaneous coronary intervention (71.5%; n = 188). Unrevascularized patients (24.0%; n = 63) were older (P < .001), more often female (P < .001), more comorbid, less likely to have anterior AMI (P < .001), or treated with anticoagulation (P < .001). In multivariable analysis, at least anticoagulation + P2Y12 inhibitor (adjusted hazard ratio [aHR], 1.84; 95% CI, 1.14-2.96; P = .01), but not revascularization (aHR, 1.25; 95% CI, 0.74-2.13; P = .40), was associated with LVT resolution. Both absence of revascularization (aHR, 2.30; 95% CI, 1.09-4.85; P = .03) and LVT resolution (aHR, 6.06; 95% CI, 2.99-12.3; P < .001) were associated with higher mortality after adjusting for age, sex, anemia, anterior AMI, and ejection fraction.

Lack of revascularization in post-AMI LVT patients was associated with higher mortality but not LVT resolution. Optimizing medical therapy remains a key treatment goal.

•Left ventricular thrombus (LVT) formation is a significant complication in postacute myocardial infarction (AMI) patients. The impact of revascularization in such patients is unclear.•This was a retrospective study from a single center of 263 consecutive post-AMI patients with LVT from 2012 to 2021 in an echocardiography database, stratified by revascularization status.•Lack of revascularization in post-AMI LVT patients was associated with higher mortality but not LVT resolution.•Optimizing medical therapy remains a key treatment goal.

Left ventricular thrombus (LVT) formation is a significant complication in postacute myocardial infarction (AMI) patients. The impact of revascularization in such patients is unclear.

This was a retrospective study from a single center of 263 consecutive post-AMI patients with LVT from 2012 to 2021 in an echocardiography database, stratified by revascularization status.

Lack of revascularization in post-AMI LVT patients was associated with higher mortality but not LVT resolution.

Optimizing medical therapy remains a key treatment goal.