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European Heart Journal 1996 17(3):421-428;
Copyright © 1996 by the European Society of Cardiology.
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© 1996 The European Society of Cardiology

Thrombolytic therapy reduces the incidence of left ventricular thrombus after anterior myocardial infarction

Relationship to vessel patency and infarct size

G. Pizzeti, G. Belotti, A. Margonato, M. Carlino, S. Gerosa, O. Carandente and S. L. Chierchia

Department of Cardiology, Istituto Scientifico H S Raffaele Milano, Italy

Received 17 July 1995; accepted 7 August 1995.

Correspondence:Giuseppe Pizzetti, Department of Cardiology, Istituto Scientifico H S Raffaele, Via Olgettina, 60-20132 Milano, Italy

Abstract

BACKGROUND: Controversial evidence exists as to whether thrombolytic therapy reduces the incidence of left ventricular thrombus in acute myocardial infarction and, if so, how this relates to successful reperfusion.

METHODS: Four hundred and eighteen consecutive patients underwent echocardiography and coronary angiography within 3 weeks of an acute myocardial infarction. A dyssynergic score was calculated by analysing regional wall motion in 18 left ventricular segments. The infarct-related artery was considered patent if TIMI grade 2 or 3 flow and less than 90% stenosis were present. Retrograde perfusion by Rentrop's grade 2 or 3 collaterals was considered significant.

RESULTS: Large anterior myocardial infarctions were associated with the highest prevalence (39%) of left ventricular thrombosis. Thrombus was also very frequent if the left anterior descending coronary artery was occluded and no collaterals to the infarct area were seen (75%). Anticoagulant therapy reduced the prevalence of left ventricular thrombus, regardless of whether the infarct-related vessel was patent or not. Conversely, in patients undergoing thrombolysis the incidence of left ventricular thrombosis was lower when the left anterior descending coronary artery was patent, and especially when an early creatine kinase peak, suggestive of reperfusion, was recorded (7%). Finally, the presence of left ventricular thrombosis was inversely related to the asynergy score.

CONCLUSION: These observations suggest that the presence of left ventricular thrombus is related to the extent of myocardial damage. Thrombolytic therapy reduces thrombus probably by salvaging myocardium at risk.

(Eur Heart J 1996; 17: 421–428)

Key Words: Left ventricular thrombus • acute myocardial infarction • thrombolytic therapy


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