NEW YORK (Reuters Health) – Left ventricular thrombus is still quite a frequent finding in patients with an anterior wall MI who have been treated by percutaneous coronary intervention (PCI) and dual antiplatelet therapy, a Norwegian team reports.

They point out that the LV thrombus rate in patients with anterior wall infarcts was as high as 60% before the introduction of thrombolysis. To investigate the occurrence of LV thrombi now that ST-elevation MI is mostly treated by PCI and antiplatelet therapy, they looked at 100 such patients with culprit lesions in the left anterior descending artery.

“All patients were treated successfully with PCI and stent implantation and dual-antiplatelet therapy within 2 to 12 hours of symptom onset,” Dr. Svein Solheim, with Oslo University Hospital in Ulleval, Norway and colleagues report in the American Journal of Cardiology online September 9.

Serial echocardiography and magnetic resonance imaging during the first 3 months after PCI detected 15 cases of LV thrombus, 10 of them within the first week.

No baseline characteristics distinguished patients with thrombi from those without, the investigators found. However those with thrombi had larger infarct sizes than those without (LAD area 82.5% vs 63.8%), lower ejection fractions (35.5% vs 44.0%) and higher peak levels of creatine kinase (6128 vs 2197 mcg/L).

“Importantly, 20% of the patients with LV thrombi in our study received thrombolysis before acute PCI, and about 50% were treated with glycoprotein IIb/IIIa receptor blockers, and 15% still developed mural thrombosis,” Dr. Solheim and colleagues note.

They add, “In accordance with the present guidelines, patients with LV thrombi in our study were treated with low-molecular weight heparin and further warfarin.” Only one patient had a minor cerebral stroke.

Reference:
Frequency of Left Ventricular Thrombus in Patients With Anterior Wall Acute Myocardial Infarction Treated With Percutaneous Coronary Intervention and Dual Antiplatelet Therapy
Am J Cardiol 2010.