Coronary heart disease: systemic embolism was not very common.

Clinical bottom line (level 4)

1% of patients with left ventricular aneurysm will had a systemic embolism at 5 years.
A third of patients with left ventricular aneurysm had died at 5 years.

Lapeyre et al: Journal of the American College of Cardiology 1985; 6 (3): 534-538

Expires March 2003

The study

Case series with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university teaching hospital clinic records, USA

76 patients (aged range 35 to 77 years; mean 58, ?% male) left ventricular aneurysm diagnosed by ventriculogram and documented in records

Excluded if

treatment was primarily surgical

systemic embolism
death

The evidence

outcome	time to outcome	number of patients/total number	% (95% CI)
systemic embolism	median 5 years	1/76	1.3% (0.03% to 7.8%)
death	median 5 years	28/76	36.8% (26.0% to 47.7%)

There were 20 patients in this cohort who were taking anticoagulation therapy and 69 were not (13 patients were in both subsets according to when they were/were not taking it). The patient who had the embolism was in the non-anticoagulation group, but the other 19 patients were free from embolism.

Comments

This was a note-review, without explicit details for the diagnosis or exclusion of systemic embolism. Duration and intensity of anticoagulation, as well as reasons for commencement and discontinuation of therapy were poorly documented. It is very difficult to extrapolate from this into information to treat or not to treat with anticoagulants.

Citation

Lapeyre AC, Steele PM, Kazmier FJ, et al: Systemic embolism in chronic left ventricular aneurysm: Incidence and the role of anticoagulation. Journal of the American College of Cardiology 1985; 6 (3): 534-538

_{Clinical Question.}

_Patient	_{left ventricular aneurysm}
_{Intervention or Exposure}	_{occurrence of}
_Outcome	_{systemic embolism}