<b>Frequency of Left Ventricular Thrombus at 72 Hours in Patients Presenting with Acute Anterior Wall Myocardial Infarction at Peshawar Institute of Cardiology</b>

Background: Left ventricular thrombus (LVT) is a well-recognized complication of acute anterior wall myocardial infarction (AWMI), associated with an elevated risk of embolic events. While international data suggest an LVT incidence ranging from 5% to 38% depending on population and imaging modality, there is limited evidence from South Asian populations, where cardiovascular risk profiles and healthcare delivery contexts differ substantially. Objective: To determine the frequency of LVT formation at 72 hours post-admission and identify associated clinical and echocardiographic risk factors in patients presenting with AWMI at the Peshawar Institute of Cardiology. Methods: This cross-sectional observational study included 278 adult patients with AWMI admitted within 24 hours of symptom onset between December 1, 2024, and May 31, 2025. Consecutive sampling was employed. Echocardiography was performed at admission and repeated at 72 hours to detect LVT. Demographic, clinical, and echocardiographic data were analyzed using SPSS v23.0, with multivariate logistic regression employed to identify independent predictors. Results: LVT was identified in 17.3% (48/278) of patients, predominantly at the left ventricular apex (87.5%). Independent predictors of LVT included reduced left ventricular ejection fraction (OR: 1.12 per 1% decrease; p<0.001), anterior wall akinesia (OR: 7.94; p=0.005), diabetes mellitus (OR: 2.19; p=0.032), smoking (OR: 2.02; p=0.044), and higher troponin I levels (OR: 1.09 per ng/mL; p=0.034). All embolic complications and in-hospital deaths occurred among patients with LVT. Conclusion: Approximately one in six patients with AWMI develops LVT within 72 hours, with clear clinical and echocardiographic predictors identifying a high-risk subgroup. Routine echocardiographic screening should be considered in these patients to enable early anticoagulation and prevent embolic complications.