Frequency and Predictors of Left Ventricular Thrombus in Patients with Acute Anterior Wall Myocardial Infarction: A Cross-Sectional Study from a Tertiary Care Cardiac Centre in Pakistan.

Abstract

Background: Left ventricular thrombus (LVT) is a significant complication of acute anterior wall myocardial infarction (AWMI), increasing the risk of systemic embolism, stroke, and adverse outcomes. This study aimed to determine the frequency of LVT and identify clinical predictors among patients with acute AWMI.

Methodology: An analytical cross-sectional study was conducted at the Department of Cardiology, Hayatabad Medical Complex, Peshawar, Pakistan, from July to December 2025. Ninety-one consecutive patients with acute AWMI were enrolled. Demographics, cardiovascular risk factors, ischemic time, and door-to-balloon time were recorded. Transthoracic echocardiography (TTE) was performed within 72 hours of admission to detect LVT. Associations between risk factors and LVT were analyzed using Chi-square tests, and independent predictors were identified via multivariable logistic regression. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported; p<0.05 was considered significant.

Results: LVT was detected in 20 patients (22%). On univariate analysis, hypertension (p=0.02) and diabetes mellitus (p=0.03) were significantly associated with LVT. After adjustment, diabetes mellitus (aOR=2.59, 95% CI: 1.37–4.88, p=0.003), smoking (aOR=3.07, 95% CI: 1.70–5.53, p=0.0002), and prolonged ischemic time (aOR=1.015 per minute, 95% CI: 1.005–1.025, p=0.0025) emerged as independent predictors. Door-to-balloon time was not significantly associated (p=0.11).

Conclusion: One in five patients with acute AWMI developed LVT. Diabetes, smoking, and delayed presentation independently predict thrombus formation. These findings highlight the need for timely reperfusion, reduction of pre-hospital delays, aggressive management of modifiable risk factors, and echocardiographic screening in high-risk patients. Larger multicenter studies using advanced imaging are warranted to validate these findings and improve risk stratification.