PREDISCHARGE 2-DIMENSIONAL ECHOCARDIOGRAPHIC EVALUATION OF LEFT-VENTRICULAR THROMBOSIS AFTER ACUTE MYOCARDIAL-INFARCTION IN THE GISSI-3 STUDY

Left ventricular (LV) thrombosis can be found in patients with acute m yocardial infarction (AMI). No wide multicenter trial on AMI has provi ded information about LV thrombosis until now, The protocol of the GIS SI-3 study included the search for the presence of LV thrombosis in pa tients from 200 coronary care units that did not specifically focus on LV thrombosis. We examined the GISSI-3 database results related to 8, 326 patients at low to medium risk for LV thrombi in which a predischa rge echocardiogram (9 +/- 5 days) was available. LV thrombosis was fou nd in 427 patients (5.1%): 292 of 2,544 patients (11.5%) with anterior AMI and in 135 of 5,782 patients (2.3%) with AMI in other sites (p <0 .0001). The incidence of LV thrombosis was higher in patients with eje ction fraction less than or equal to 40% (151 of 1,432 [10.5%] vs 276 of 6,894 [4%]; p <0.0001) both in the total population and in the subg roup with anterior AMI (106 of 597 [17.8%] vs 186 of 1,947 [9.6%]; p < 0.0001). Multivariate analysis showed that only the Killip class >1 an d early intravenous beta-blocker administration were independently ass ociated with higher LV thrombosis risk in the subgroup of patients wit h anterior AMI (odds ratio 1.75, 95% confidence interval 1.28 to 2.39; odds ratio 1.32, 95% confidence interval 1.02 to 1.72, respectively), In patients with anterior AMI, oral beta-blocker therapy given or not given after early intravenous beta-blocker administration does not in fluence the occurrence of LV thrombosis. The rate of LV thrombosis was similar in patients treated or not treated with nitrates and lisinopr il both in the total population and in patients with anterior and nona nterior AMI. In conclusion, in the GISSI-3 population at low to medium risk for LV thrombi, the highest rate of occurrence of LV thrombosis was found among patients with anterior AMI and an election fraction <4 0%, Killip class >1 and the early intravenous beta-blocker administrat ion were the only variables independently associated with a higher pre discharge incidence of LV thrombosis after anterior BMI. (C) 1998 by E xcerpta Medica, Inc.