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

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

Research output: Contribution to journalArticle

24 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)421-428
Number of pages8
JournalEuropean Heart Journal
Volume17
Issue number3
Publication statusPublished - 1996

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Thrombolytic Therapy
Thrombosis
Myocardial Infarction
Incidence
Reperfusion
Coronary Vessels
Creatine Kinase
Coronary Angiography
Anticoagulants
Echocardiography
Myocardium
Pathologic Constriction
Arteries
Perfusion

Keywords

  • Acute myocardial infarction
  • Left ventricular thrombus
  • Thrombolytic therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Thrombolytic therapy reduces the incidence of left ventricular thrombus after anterior myocardial infarction. / Pizzetti, G.; Belotti, G.; Margonato, A.; Carlino, M.; Gerosa, S.; Carandente, O.; Chierchia, S. L.

In: European Heart Journal, Vol. 17, No. 3, 1996, p. 421-428.

Research output: Contribution to journalArticle

Pizzetti, G, Belotti, G, Margonato, A, Carlino, M, Gerosa, S, Carandente, O & Chierchia, SL 1996, 'Thrombolytic therapy reduces the incidence of left ventricular thrombus after anterior myocardial infarction', European Heart Journal, vol. 17, no. 3, pp. 421-428.
Pizzetti, G. ; Belotti, G. ; Margonato, A. ; Carlino, M. ; Gerosa, S. ; Carandente, O. ; Chierchia, S. L. / Thrombolytic therapy reduces the incidence of left ventricular thrombus after anterior myocardial infarction. In: European Heart Journal. 1996 ; Vol. 17, No. 3. pp. 421-428.
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AB - 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.

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