The relationship between CHA2DS2VASc score and left ventricular apical thrombus formation in patients with acute anterior ST segment elevation myocardial infarction

Abstract

Background:Left ventricular apical thrombus(LVAT) formation is a well-known complication ofacute anterior myocardial infarction (AMI). The CHA2DS2VASc is a scoring system that has beenused to estimate the risk of thromboembolism in patients with nonvalvular atrial fibrillation.This score has also been used for other clinical conditions. The aim of this study was to investi-gate the relationship between CHA2DS2VASc score and development of LVAT in patientswith AMI.Method:The study population included 378 patients (mean age: 56.5 ±12.3 years, male: 318)presenting with AMI between January 2016 and January 2020. Primary percutaneous coronaryintervention procedure was performed in all patients. Initial echocardiogram was performedwithin 7 days of admission. All patients were evaluated with echocardiography at 3rd, 6th and12th months. Patients were divided into two groups according to the presence of LVAT onechocardiography.Results:The incidence of the LVAT was 8.5% (n¼32) during a mean follow-up time of233.1 ±66.7 days. The mean CHA2DS2VASc score was notably higher in patients with LVAT com-pared to patients in the control group (3.1 ±1.9 vs. 1.9 ± 1.2,p<0.001). In Cox regression ana-lysis, high CHA2DS2VASc score, low left ventricular ejection fraction (LVEF) and the presence ofLV apical akinesis/aneurysm were the independent predictors for LVAT formation. All of theseparameters were associated with higher cumulative incidence of LVAT formation in Kaplan-Meier analyses (p<0.001 for all).Conclusion:High CHA2DS2VASc score, low LVEF and the presence of LV apical akinesis/aneur-ysm may be used for LVAT risk prediction among patients presenting with AMI.