Serum lipoprotein(a) and its relation to left ventricular thrombus in patients with acute myocardial infarction

It is well known that the incidence of left ventricular (LV) thrombosis is high in patients with acute myocardial infarction (AMI). Due to the high de gree of structural homology with plasminogen, lipoprotein(a) may produce th rombogenic effects by modulating the fibrinolytic system. However, the role of Lp(a) level in the formation of LV thrombus has not been studied. This study sought to determine whether Lp(a) is a risk factor for LV thrombus in patients with AMI. We have analyzed clinical, echocardiographic and biochemical data in 102 co nsecutive patients (aged 58 +/- 12 years: 92 men / 10 women) with first ant erior AMI. Two-dimensional examination was performed on days 1,3, 7, 15, an d 30. Blood samples were obtained within 12 h after the onset of symptoms a nd before beginning the therapy. Plasma levels of fibrinogen and Lp(a) were measured using enzyme-linked immunosorbent assay and immunonephelometric m ethods. respectively. LV thrombus was detected in 20 (20.3 %) patients. No significant difference was found for admission Lp(a) levels between patient s with or without thrombus (30.5 +/- 17.2 vs 32.3 +/- 22.3 mg / dl, p = 0.7 ). Univariate analysis showed that patients with LV thrombus had a higher a ll motion score index(1.8 +/- 0.3 vs 1.4 +/- 0.3, p = 0.002), a higher peak creatine kinase level (2945 +/- 898 vs 1805 +/- 1336, I/U p = 0.004), a la rger end-diastolic volume (139.7 +/- 38.6 vs 114.1 +/- 41.8 ml, p = 0.04), a larger end-systolic volume (83.1 +/- 34.3 vs 59.2 +/- 30.6 ml, p = 0.02). and a lower ejection fraction (38 +/- 12 vs 47 +/- 11, p = 0.04). In multi variate analyses, only peak creatine kinase level (p = 0.04) and LV wall mo tion score index (p = 0.002) were independent predictors of left ventricula r thrombus formation. These results suggest that Lp (a) is not a risk factor for LV thrombus in p atients with AMI. Our data demonstrate that the best predictors of LV throm bus formation after AMI are a high peak creatine kinase level and a high LV wall motion score index.