Previous studies using 2-dimensional non-contrast echocardiography have reported a post-
ST segment elevation myocardial infarction (
STEMI) left ventricular (LV)
thrombus incidence of 3% to 24%. However, these studies were not performed with ultrasound
contrast agents (UCAs), which improve accuracy in the diagnosis of LV
thrombus. We aimed to determine the early incidence and clinical correlates of LV
thrombus in a large consecutive cohort of patients with
STEMI. This study included consecutive patients admitted to Saint Luke's Mid America Heart Institute with
STEMI who also underwent early
percutaneous coronary intervention (PCI) and an echocardiogram. A total of 1,698 patients (1,205 men, mean age 61 ± 13 years) comprised the study group. Echocardiography was performed on hospital day 2, and a UCA was used in 1,292 patients (76%). LV
thrombus was identified in 28 (1.6%) patients. A multivariable logistic regression model showed that left anterior descending intervention was independently associated with LV
thrombus (odds ratio = 7.58, 95% confidence interval [CI] 2.20 to 26.19, p = 0.001), thrombolysis in
myocardial infarction III flow was marginally associated with less LV
thrombus (odds ratio = 0.41, 95% CI 0.16 to 1.04, p = 0.060), and higher LVEF was associated with less LV
thrombus (odds ratio = 0.96, 95% CI 0.91 to 0.97, p <0.001). In conclusion, LV
thrombus was identified in only 1.6% of patients in a large
STEMI cohort, significantly lower than previous studies. A UCA was used in most echocardiograms, and it improves accuracy in the detection and exclusion of LV
thrombus.