Percutaneous coronary intervention can be safely performed with left ventricular thrombus without increasing stroke risk: A 5-year retrospective review using real-world data

Mohanad Shehadeh; Alaa Rahhal; Khaled Shunnar; Ashraf Omer Ahmed; Osama AlKhalaila; Mohamed Abdelghani; Ahmed Mahfouz; Sumaya Alyafei; Abdulrahman Arabi

doi:10.1016/j.ijcard.2023.131415

Percutaneous coronary intervention can be safely performed with left ventricular thrombus without increasing stroke risk: A 5-year retrospective review using real-world data

Int J Cardiol. 2024 Jan 15:395:131415. doi: 10.1016/j.ijcard.2023.131415. Epub 2023 Oct 5.

Authors

Mohanad Shehadeh¹, Alaa Rahhal², Khaled Shunnar³, Ashraf Omer Ahmed⁴, Osama AlKhalaila¹, Mohamed Abdelghani¹, Ahmed Mahfouz², Sumaya Alyafei², Abdulrahman Arabi¹

Affiliations

¹ Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
² Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
³ Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar. Electronic address: khaledshunnar@gmail.com.
⁴ Internal Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.

PMID: 37802297
DOI: 10.1016/j.ijcard.2023.131415

Abstract

Introduction: Left ventricular thrombus (LVT) increases the risk of ischemic stroke. However, it remains uncertain if the percutaneous coronary intervention (PCI) in the confirmed LVT setting further augments the stroke risk. Therefore, in this study, we evaluated the risk of stroke among patients with LVT undergoing CAG +/- PCI.

Methods: This retrospective observational cohort study included all the patients encountered with LVT from 1st of April 2015, to 31st of March 2020. The study population was divided into two groups: Longobardo et al. (2018) [1] patients with LVT who underwent CAG +/- PCI; Solheim et al. (2010) [2] patients with LVT who did not undergo CAG +/- PCI. The primary outcome evaluated was stroke during the index admission, and the secondary outcomes included in-hospital mortality, all-cause mortality, and stroke at 12 months post-discharge. Logistic regression was used to determine the risk of stroke associated with PCI among patients with LVT, and a p-value<0.05 indicated statistical significance.

Results: Of the 210 patients included, 119 underwent CAG +/- PCI, while 91 patients did not undergo CAG +/- PCI. Most of the patients were Asian (67%), male (96%), with a mean age of 56 years. Ischemic cardiomyopathy was the primary etiology of LVT in both groups (96% in the CAG +/- PCI group and 80% in non CAG +/- PCI group). During the index admission, stroke among patients with LVT did not differ between the CAG +/- PCI and non CAG +/- PCI groups (5% versus 3.3%; odds ratio (OR) 1.6, 95% confidence interval (CI) 0.34-6.4, p = 0.539; adjusted OR 0.9, 95% CI 0.09-10.6, p = 0.968). Similarly, in-hospital mortality, all-cause mortality, and stroke at 12 months did not differ between the study groups.

Conclusion: Performing CAG +/- PCI among patients with LVT was not associated with an increased risk of stroke during admission or within 12 months in comparison to patients who did not undergo CAG +/- PCI, which may reassure cardiologists to perform CAG +/- PCI among patients with LVT safely.

Keywords: Left ventricular thrombus; Myocardial infarction; Percutaneous coronary intervention; Stroke.

Publication types

Observational Study

MeSH terms

Aftercare
Humans
Male
Middle Aged
Patient Discharge
Percutaneous Coronary Intervention* / adverse effects
Retrospective Studies
Stroke* / diagnosis
Stroke* / epidemiology
Stroke* / etiology
Thrombosis* / epidemiology
Treatment Outcome