BACKGROUND: Current evidence suggests a link between inflammatory state and left ventricular (LV) thrombus formation following ST-elevation myocardial infarction (STEMI). However, a comprehensive study investigating the association between inflammatory biomarkers and LV thrombus diagnosed by cardiac magnetic resonance (CMR) is lacking.

METHODS: We studied 309 patients with acute STEMI treated with primary percutaneous coronary intervention (PCI) from the prospective Magnetic Resonance Imaging in Acute ST-Elevation Myocardial Infarction (MARINA-STEMI) cohort study. Concentrations of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), white blood cell count (WBCc), fibrinogen and D-dimer were measured 2 days after STEMI. The presence of LV thrombus was assessed with the use of contrast-enhanced CMR at a median of 4 (interquartile range [IQR] 3-5) days after primary PCI.

RESULTS: In total, 309 STEMI patients (18% female) with a median age of 57 (IQR 52-65) years were included. An LV thrombus was observed in 8% (n=24) of the overall cohort and in 15% of patients with an anterior STEMI. While levels of hs-CRP (OR 2.16, 95% CI, 1.54-3.02, p<0.001), IL-6 (OR 2.38, 95% CI, 1.48-3.81, p<0.001) and fibrinogen (OR 2.05, 95% CI, 1.40-3.00, p<0.001) were significantly associated with presence of LV thrombus, levels of D-dimer and WBCc were not associated with LV thrombus. In multivariable regression analysis, hs-CRP emerged as the sole independent predictor of LV thrombi among inflammatory biomarkers (OR 2.16, 95% CI, 1.54-3.02, p<0.001).

CONCLUSION: In patients with STEMI treated with PPCI, inflammatory markers (hs-CRP, IL-6 and fibrinogen) are associated with the presence of LV thrombus. However, only hs-CRP was independently associated with LV thrombus, suggesting an underlying pathophysiological link between CRP and the formation of LV thrombi.