Coronary artery disease
Frequency of Left Ventricular Thrombus in Patients With Anterior Wall Acute Myocardial Infarction Treated With Percutaneous Coronary Intervention and Dual Antiplatelet Therapy

https://doi.org/10.1016/j.amjcard.2010.06.043Get rights and content

The aim of the present study was to investigate the prevalence of left ventricular (LV) thrombus formation and important determinants in patients with acute ST elevation myocardial infarction localized to the anterior wall treated with percutaneous coronary intervention (PCI) and dual-antiplatelet therapy. One hundred selected patients with ST elevation myocardial infarctions revascularized with PCI in the left anterior descending coronary artery were included. The patients participated in the Autologous Stem Cell Transplantation in Acute Myocardial Infarction (ASTAMI) trial. All were treated with aspirin 75 mg/day and clopidogrel 75 mg/day and underwent serial echocardiography and magnetic resonance imaging during the first 3 months after PCI. After 4 to 5 days, the ejection fraction and infarct size in percentage of the left anterior descending coronary artery area were assessed using single photon-emission computed tomography in addition to the ejection fraction by echocardiography. LV thrombi were detected in 15 patients during the first 3 months, 2/3 of them within the first week. No differences in baseline characteristics between the groups with and without LV thrombi were shown. However, in the thrombus group, significantly higher peak creatine kinase levels (6,128 vs 2,197 U/L, p <0.01), larger infarct sizes (82.5% vs 63.8%, p <0.01), and lower ejection fractions on single photon-emission computed tomography (35.5% vs 40.0%, p = 0.03) and on echocardiography (43.0% vs 46.0%, p = 0.03) were found compared to patients without LV thrombi. In conclusion, LV thrombus formation is a frequent finding in patients with anterior wall ST elevation myocardial infarction treated acutely with PCI and dual-antiplatelet therapy and should be assessed by echocardiography within the first week.

Section snippets

Methods

We examined patients (n = 100) participating in the Autologous Stem Cell Transplantation in Acute Myocardial Infarction (ASTAMI) trial included at Ullevål University Hospital and Rikshospitalet University Hospital (Oslo, Norway).13 Patients were aged 40 to 75 years, of both genders, with acute anterior wall ST elevation myocardial infarctions and culprit lesions located in the left anterior descending coronary artery, proximal to the diagonal branch. All patients were treated successfully with

Results

LV thrombi were detected in 15 of the 100 patients within the first 3 months after the AMI: 6 of the patients allocated to the mBMC group and 9 of those allocated to the control group (p = 0.58 for the difference between the groups). One of the patients experienced a minor cerebral stroke. As visualized in Figure 1, most of the LV thrombus formation was detected within the first week after acute PCI. LV thrombi were diagnosed by echocardiography in 13 patients and by magnetic resonance imaging

Discussion

Our study of selected patients with acute anterior wall ST elevation myocardial infarctions treated successfully with PCI and intensive antiplatelet treatment confirms that LV thrombus remains a frequent finding. Although patients with the most extensive myocardial infarcts with cardiogenic shock were excluded, LV thrombi were detected in 15 of 100 patients. In recent years, acute PCI has been the preferred revascularization method in patients with ST elevation myocardial infarctions, with an

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