Intraventricular Thrombosis After Myocardial Infarction: Prognostic Evaluation in Relation to Microvascular Obstruction Extent by CMR

(1) <b>Background</b>: There are few data on anticoagulation therapy for left ventricular (LV) thrombosis following ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess whether microvascular obstruction (MVO) extent on cardiac magnetic resonance (CMR) worsened the prognosis of patients with LV thrombosis receiving anticoagulation. (2) <b>Methods</b>: reperfused STEMI patients undergoing CMR were enrolled. Patients were divided into 4 groups according to MVO and LV thrombosis presence or absence. Occurrence of major adverse cardiac events (MACE) was evaluated during follow-up. (3) <b>Results</b>: 80 STEMI patients were enrolled. According to MVO and LV thrombosis, 4 subgroups were obtained: patients with MVO and LV thrombosis (21 patients, 26%); patients with MVO without LV thrombosis (28 patients, 35%); patients without MVO with LV thrombosis (6 patients, 8%); patients without MVO and LV thrombosis (25 patients, 31%). All patients with LV thrombosis were treated with anticoagulation therapy. The median time to the follow-up was 11 months. Twenty-two patients (27%) experienced MACE. LV thrombosis treated with anticoagulation was an independent predictor of MACE (hazard ratio, 2.828; 95% confidence interval, 1.205-6.638; <i>p</i> = 0.017) and was associated with a worse prognosis (<i>p</i> = 0.012), regardless of MVO (<i>p</i> = 0.852), at Kaplan-Meier. (4) <b>Conclusions</b>: Patients with LV thrombosis treated with anticoagulation after a reperfused STEMI have a worse prognosis than those without; however, MVO extent did not worsen prognosis.