LEFT-VENTRICULAR THROMBOSIS AFTER ANTERIOR MYOCARDIAL-INFARCTION WITHAND WITHOUT THROMBOLYTIC TREATMENT

Objectives. To examine the incidence of left ventricular thrombus in p atients with anterior myocardial infarction, with and without streptok inase treatment. To identify predictors of thrombus development. Desig n. Consecutive patients prospectively studied during the hospitalized period. Echocardiography was performed within 3 days of admission and before discharge. Setting. Umea University Hospital, a teaching hospit al in Northern Sweden. Subjects. Ninety-nine patients with anterior my ocardial infarction of whom 74 were treated with streptokinase. Main o utcome measures. Left ventricular thrombus and left ventricular segmen tal myocardial function. Results. During the hospital stay, a thrombus developed in 46% (95% confidence interval [ICI], 35-57%) of the patie nts in the thrombolysis group and in 40% (95% CI, 21-59%) of the patie nts in the non-thrombolysis group. No difference in left ventricular s egmental myocardial function was found between the thrombolysis and no n-thrombolysis groups at hospital discharge. No embolic events were ob served. The occurrence of a left ventricular thrombus at hospital disc harge was significantly associated with previous myocardial infarction , peak enzyme levels, left ventricular global and segmental dysfunctio n and an increased dose of peroral diuretics or use of parenteral diur etics. In a multiple logistic regression model, left ventricular segme ntal dysfunction was the most important predictor of left ventricular thrombus. Conclusion. Thrombolytic treatment with streptokinase does n ot prevent the development of a left ventricular thrombus but the risk of embolic complications is low. The left ventricular segmental myoca rdial score can be used to assess the risk of thrombus development, al so, after thrombolysis.