Abstract 4147422: Risk of Stroke in Patients with Left Ventricular Thrombosis who undergo Coronary Angiography: A system-wide Retrospective Analysis

Background: Left ventricular thrombus (LVT) has been associated with an increased risk of cardioembolic stroke. However, it has not been established if coronary angiography (CAG) or percutaneous intervention (PCI) would enhance that risk. This study aims to determine the risk of cardioembolic stroke among patients with LVT who underwent CAG or PCI. Methods: This retrospective study includes patients diagnosed with LVT between June 1 st , 2017, and May 31 st , 2023 across the Yale New Haven Health System. The data was retrieved using ICD-10 and CPT codes, followed by manual review of the patients’ charts. The patients were divided into two groups, those who had a stroke versus those who did not. The data retrieved includes patient demographics, pre-existing medical conditions, LV function as assessed by echocardiogram, along with the findings on CAG and PCI. The statistical analyses were performed using t-test, ANOVA, and Fisher's exact test. Results: A total of 1,104 charts were manually reviewed, of which 311 patients met the inclusion criterion of a confirmed LVT. Among these, 54 patients (17.4%) experienced an ischemic stroke. The mean age of these patients was 65.3 ± 14.8 years, with 219 patients (70.4%) being male, of whom 39 had a stroke. Among all the studied parameters (Table 1), only CAG was found to be associated with a significantly increased risk of stroke in these patients (RR: 1.47, 95% CI: 1.04-2.09, P = 0.014). There was no significantly increased risk of stroke among those patients who underwent PCI. Conclusion: Coronary angiography appears to carry a significantly increased risk of cardioembolic stroke among patients with LVT in a 6-month follow-up period, that is independent of subsequent percutaneous coronary intervention. Clinicians should carefully weigh the benefits and risks of CAG in patients with LVT and consider alternative diagnostic and therapeutic strategies when appropriate. Further studies are recommended to identify specific patient populations that might benefit from more targeted stroke prevention strategies post angiography.