C-reactive protein as a risk factor for left ventricular thrombus in patients with acute myocardial infarction

Background: Elevated C-reactive protein (CRP) has been found to correlate w ith higher risk for cardiac events in patients with acute myocardial infarc tion (ANI). It has been suggested that CRP may be involved in initiation pr ocess of coagulation; however, the role of CRP level in the formation of le ft ventricular (LV) thrombus has not been studied. Hypothesis: This study investigated whether CRP is a risk factor for LV thr ombus in patients with AMI. Methods: Clinical, echocardiographic, and biochemical data were analyzed in 141 consecutive patients (aged 57 +/- 13 years; 33 women) with first anter ior AMI. Two-dimensional and Doppler echocardiographic examinations were pe rformed on Days 1, 3, 7, 15, and 30. Blood samples were obtained every day during hospitalization. Serum CRP concentrations were measured by an ultras ensitive immunonephelometry method. Results: Left ventricular thrombus was detected in 33 (23.4%) patients. Uni variate analysis showed that patients with IV thrombus had a higher peak cr eatine kinase (CK) level (2879 +/- 742 vs. 1693 +/- 1210 I/U, p = 0.001), h igher peak CRP level (14.9 +/- 7.1 vs. 9.2 +/- 6.8 mg/dl, p = 0.001), highe r wall motion score index (1.8 +/- 0.2 vs. 1.5 +/- 0.3, p = 0.002), higher apical wall motion score index (2.35 +/- 0.72 vs. 2.07 +/- 0.70, p = 0.001) , larger end-diastolic volume (145.2 +/- 43.7 vs. 116.5 +/- 44.2 ml, p = 0. 002), larger end-systolic volume (85.4 +/- 37.2 vs. 62.9 +/- 31.6 ml, p = 0 .003), and lower ejection fraction (42.1 +/- 12 vs. 47.3 +/- 13, p = 0.04). In multivariate analyses, only peak CK level (p = 0.0001), LV apical wall motion score index (p = 0.001), and CRP levels (p = 0.001) were independent predictors of IV thrombus formation. Conclusions: These results suggest that CRP is a risk factor for LV thrombu s in patients with AMI.