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Abstract

Background: Coronary heart disease continues to be a major global cause of morbidity and mortality, with anterior wall myocardial infarction (MI) posing a heightened risk of complications such as left ventricular (LV) thrombus. LV thrombus can result in systemic embolization, stroke, and worsened cardiac outcomes. Despite advancements in reperfusion therapy, early detection and management of LV thrombus remain limited in many low-resource settings, particularly in South Asia, where access to timely interventions is still developing.
Objective: To determine the prevalence of left ventricular thrombus in patients with anterior wall myocardial infarction and identify clinical and demographic factors associated with its development.
Methods: A cross-sectional study was conducted at the Cardiology Department of Mardan Medical Complex from September 2024 to March 2025. A total of 227 patients diagnosed with acute anterior wall MI were enrolled based on ECG findings and elevated cardiac biomarkers. Transthoracic echocardiography was performed within 72 hours of admission to evaluate LV thrombus and ejection fraction. Data on age, gender, comorbidities, thrombolytic therapy, and lifestyle factors were collected using a structured proforma. Statistical analysis was conducted using SPSS version 26, with chi-square and t-tests applied to assess associations (p≤0.05).
Results: The mean age was 57.4 ± 11.49 years, with 66.1% males and 83.7% rural residents. Hypertension was noted in 58.6%, diabetes mellitus in 41.9%, and dyslipidemia in 56.8%. Smoking was reported in 22.5%, and obesity in 30.8%. Thrombolytic therapy was given to 41.9% of patients, and 20.3% were physically inactive. Reduced LVEF (<40%) was observed in 50.7% of patients. LV thrombus was detected in 15 patients (6.6%). Significant associations were found with obesity (p=0.001), absence of thrombolysis (p=0.001), physical inactivity (p=0.016), and reduced LVEF (p=0.001).
Conclusion: LV thrombus is a critical complication in anterior wall MI, with a notable association with reduced ejection fraction and modifiable risk factors such as obesity and delayed reperfusion. Focused interventions including early thrombolysis, lifestyle modification, and vigilant cardiac monitoring are essential to mitigate thrombotic risks and improve patient outcomes.