Predictors of left ventricular thrombus formation in patients with anterior myocardial infarction: role of activated protein C resistance

Background Left ventricular mural thrombus formation is a well-recognised c onsequence of acute anterior myocardial infarction. The vast majority of le ft Ventricular thromboses occur in patients with anterior myocardial infarc tion and depressed left ventricular function. Objective To evaluate the factors predicting left ventricular thrombus form ation in patients similar for left ventricular function and left ventricula r score indexes. Methods We evaluated 45 consecutive patients who met the inclusion criteria of anterior myocardial infarction resulting in apical, anterior or septal asynergy (akinesia, dyskinesia), without non-Q-wave myocardial infarction, dilated cardiomyopathy, or renal or hepatic dysfunction. Patients were divi ded into two groups: group I with, and group II without, left ventricular m ural thrombus. The groups were compared for clinical, echocardiographic and hematologic parameters (activated protein C resistance (APC-R), protein S and antithrombin III). Results Smoking and ACP-R were significantly greater in group I than in gro up II (P < 0.05 and P < 0.005 respectively). Multivariate regression analys is showed that APC-R was an independent risk factor for left ventricular th rombus formation in the patient group selected. Antithrombin III and protei n S concentrations were not statistically different between two groups. All other clinical and echocardiographic characteristics of the patients were similar in both groups. Conclusion APC-R is an independent risk factor for left ventricular thrombo sis in patients with anterior myocardial infarction resulting in septal or anterior and apical akinesia or dyskinesia. Coron Artery Dis 11:269-272 (C) 2000 Lippincott Williams & Wilkins.