Abstract
Background: Previous studies have reported controversial results regarding the effectiveness of systemic thrombolysis in preventing left ventricular (LV) thrombus after acute myocardial infarction (MI).
Hypothesis: This study was performed to evaluate the influences of thrombolysis, and particularly successful reperfusion, on the incidence of LV thrombus formation after acute anterior MI.
Methods: in all, 191 patients suffering from a first attack of acute anterior MI were prospectively evaluated by two‐dimensional echocardiography and coronary angiography, performed at the end of the first week and within the first two weeks of MI, respectively. Of these, 98 who presented within 12 h of onset of symptoms received intravenous streptokinase (1.5 million IU), while the remaining 93 patients who, either because of contraindications or late admission, did not receive thrombolytic treatment served as control group. All patients received aspirin and full‐dose anticoagulation with intravenous heparin. Successful reperfusion in the streptokinase group was assessed by enzymatic and electrocardiographic evidence.
Results: The overall incidence of LV thrombi was 24.6% (47/191). When all patients were evaluated, no statistically significant difference was found between the frequency of LV thrombi in the patients who had thrombolysis (22.4%) and those who did not (26.8%), despite a trend toward the formation of fewer thrombi in the initial group (p > 0.05). However, the patients who had successful reperfusion with streptokinase (n = 64) had significantly reduced incidence of LV thrombi compared with those who did not receive thrombolytic therapy (20 vs. 26.8%, p < 0.05). Stepwise multivariate analysis suggested that LV abnormal wall motion score (p = 0.01) and presence of LV aneurysm were independent predictors of LV thrombus formation in patients with acute anterior MI.
Conclusion: Not all patients who received streptokinase for acute anterior MI, but only those with successful reperfusion had reduced incidence of LV thrombi. The favorable effects of thrombolysis on LV thrombus formation are probably due to the preservation of global LV systolic function.
Keywords: left ventricular thrombus, acute anterior myocardial infarction, thrombolytic therapy, reperfusion
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References
- 1. Asinger RW, Mikell FL, Elsperger J, Hodges M: Incidence of left ventricular thrombosis after acute transmural myocardial infarction. N Engl J Med 1981; 306: 297–302 [DOI] [PubMed] [Google Scholar]
- 2. Weinreich DJ, Burken JF, Pauletto FJ: Left ventricular mural thrombi complicating acute myocardial infarction: Long term follow up with serial echocardiography. Ann Intern Med 1984; 100: 790–794 [DOI] [PubMed] [Google Scholar]
- 3. Johannessen KA, Nordrehaug JE, Gerhard L: Left ventricular thrombosis and cerebrovascular accident in acute myocardial infarction. Br Heart J 1984; 51: 553–556 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Eigler N, Mauer G, Shah PK: Effect of early systemic thrombolytic therapy on left ventricular mural thrombus formation in acute anterior myocardial infarction. Am J Cardiol 1984; 54: 261–263 [DOI] [PubMed] [Google Scholar]
- 5. Natarajan D, Hotchandan RK, Nigam PD: Reduced incidence of left ventricular thrombi with intravenous streptokinase in acute anterior myocardial infarction. Prospective evaluation by cross sectional echocardiography. Int J Cardiol 1988; 20: 201–207 [DOI] [PubMed] [Google Scholar]
- 6. Lupi G, Domenicucci S, Chiarelli F, Belotti P, Vecchio C: Influence of thrombolytic treatment followed by full dose anticoagulation on the frequency of left ventricular thrombi in acute anterior myocardial infarction. Am J Cardiol 1989; 64: 588–590 [DOI] [PubMed] [Google Scholar]
- 7. Pizzetti G, Belotti G, Margonato A, Carlino M, Gerosa S, Carandente O, Chierchia SL: Thrombolytic therapy reduces the incidence of left ventricular thrombus after anterior myocardial infarction. Eur Heart J 1996; 17: 421–428 [DOI] [PubMed] [Google Scholar]
- 8. Held AC, Gore JM, Paraskos J, Pape LA, Ball SP, Corrao JM, Alpert JS: Impact of thrombolytic therapy on left ventricular mural thrombi in acute myocardial infarction. Am J Cardiol 1988; 62: 310–311 [DOI] [PubMed] [Google Scholar]
- 9. Kontny F, Dale J, Hegrenaes L, Lem P, Soberg T, Morstol T: Left ventricular thrombosis and arterial embolism after thrombolysis in acute anterior myocardial infarction: Predictors and effects of adjunctive antithrombotic therapy. Eur Heart J 1993; 14: 1489–1492 [DOI] [PubMed] [Google Scholar]
- 10. Grambow DW, Valentini VV, Armstrong WF: Thrombolytic therapy and intravenous heparin in acute myocardial infarction do not affect the incidence of left ventricular mural thrombus formation. Am Heart J 1994; 127: 1424–1426 [DOI] [PubMed] [Google Scholar]
- 11. Vecchio C, Chiarella F, Lupi G, Belotti P, Domenicucci S: Left ventricular thrombus in anterior acute myocardial infarction after thrombolysis. A GISSI‐2 Connected Study. Circulation 1991; 84: 512–519 [DOI] [PubMed] [Google Scholar]
- 12. Lamas GA, Vaughan DE, Pfeffer MA: Left ventricular thrombus formation after first anterior wall acute myocardial infarction. Am J Cardiol 1988; 62: 31–35 [DOI] [PubMed] [Google Scholar]
- 13. Watema WT, Meijer A, Kamp O: Relation between early development of left ventricular thrombus and coronary patency after acute myocardial infarction (abstr). Circulation 1992; 86 (suppl 1): 48 [Google Scholar]
- 14. Nordrehaug JE, Johannessen KA, Van Der Lippe G: Usefulness of high dose anticoagulants in preventing left ventricular thrombus in acute myocardial infarction. Am J Cardiol 1985; 55: 1491–1493 [DOI] [PubMed] [Google Scholar]
- 15. Gruppo Italiano per lo Studio della Streptokinasi nell'Infarto Miocardico (GISSI) : Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1986; 1: 397–401 [PubMed] [Google Scholar]
- 16. Vermeer F, Wijns W, van den Brand M, Bar F, Zwaan C, Krauss XH, Remme WJ: Preservation of global and regional left ventricular function after early thrombolysis in acute myocardial infarction. J Am Coll Cardiol 1986; 7: 729–741 [DOI] [PubMed] [Google Scholar]
- 17. Gruppo Italiano per lo Studio della Streptokinasi nell'Infarto Miocardico (GISSI) : Long term effects of intravenous thrombolysis in acute myocardial infarction: Final report of the GISSI study. Lancet 1986; 1: 871–874 [PubMed] [Google Scholar]