Development of a clinical risk score for early left ventricular thrombus prediction following anterior ST-segment elevation myocardial infarction

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 left ventricular thrombus (LVT) formation post anterior STEMI.

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) (figure 1). ROC curve analysis was performed to evaluate the predictive value of the score.

68 patients were included; mean age was 66.1±13.5, with 81% of patients being male. History of previous myocardial infarction was present in 16% and 6% had a history of AF. Killip-Kimball (KK) classification at admission was class I in 57% of patients, class II in 32%, class III in 2%, and class IV in 9%. Fibrinolysis was performed in 27% of patients. The mean door-balloon time was 138.9±123.44 minutes. 13% of patients had an evolution time exceeding 12 hours. Successful reperfusion (Grade 3 in TIMI classification) was achieved in 84% of patients. Median LVEF was 41.2±8.6%; apical aneurism was present in 34%. Contrast echocardiography was performed in 56% of patients. Apical thrombus was identified in 19% of the population. The developed risk score demonstrated a clear association with thrombus formation (13% in the high-risk group; 4% in the intermediate-risk group and 1.5% in the low-risk group; p<0.01, χ2=17.02). ROC curve analysis revealed that the score had a robust predictive performance for early thrombus detection (AUC 0.82; p<0.01, 95% CI 0.68-0.95) (figure 2). High-risk classification had a significant association with apical aneurism (p<0.01; χ2=11.88), previous acute myocardial infarction (p=0.02; x2 7.87), history of chronic pulmonary disease (p=0.01; χ2=9.07) and higher KK score (p<0.01; χ2=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).

These findings suggest that the proposed risk score effectively stratifies patients based on their risk of developing left ventricular thrombus following anterior STEMI and could be used in daily practice to determine which patients should be aggressively investigated.