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Left ventricular (LV) thrombus formation in spite of intensive antiplatelet treatment in patients with acute anterior wall st-elevation myocardial infarction (STEMI) treated with PCI
Abstract number: PP-TH-427
Solheim1 S., Seljeflot1 I., Lunde2 K., Bj⊘rnerheim1 R., Aakhus2 S., Forfang2 K., Arnesen1 H.
11Cardiology, Oslo University Hospital, Ullevål 22Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
How-to-cite Solheim S, Seljeflot I, Lunde K, Bj⊘rnerheim R, Aakhus S, Forfang K, Arnesen H. Left ventricular (LV) thrombus formation in spite of intensive antiplatelet treatment in patients with acute anterior wall st-elevation myocardial infarction (STEMI) treated with PCI. Journal of Thrombosis and Haemostasis 2009; Volume 7, Supplement 2: Abstract PP-TH-427
Materials/methods: 100 well characterized patients with STEMI treated with acute PCI in LAD, treated with aspirin and clopidogrel, underwent serial echocardiography and MRI during the first 3 months after the acute PCI. All the patients participated in the ASTAMI trial (Autologous Stem cell Transplantation in Acute Myocardial Infarction). Fasting blood samples and single photon emission computed tomography (SPECT) were obtained after 4–5 days.
Results (median values): LV thrombus was detected in 15 patients during the first 3 months. No difference in baseline characteristics between the groups was shown. However, in the thrombus group we found significantly higher CK-levels and infarct size and lower ejection fraction (EF) by SPECT compared to those without thrombus. Additionally, the circulating levels of CRP were significantly higher in the thrombus group.
Table: Characteristics and results
| | No LV thrombus (n = 85) | LV thrombus (n = 15) | P-value |
|---|
| Age, years | 57 (50,64) | 63 (50,69) | 0.18 |
| Time to PCI, min | 210 (180, 330) | 240 (150, 315) | 0.78 |
| Thrombolysis | 26 (31%) | 3 (20%) | 0.60 |
| Max CK, μg/L | 2197 (1236, 4182) | 6128 (4556, 8061) | < 0.01 |
| EF, % (SPECT) | 44.0 (36.0, 49.0) | 35.5 (26.0, 45.0) | 0.03 |
| Infarct size LAD area, % (SPECT) | 63.8 (40.5, 76.8) | 82.5 (71.3, 93.1) | < 0.01 |
| CRP, mg/L | 16.1 (9.3, 22.2) | 21.6 (17.8, 24.9) | 0.02 |
Conclusion: Left ventricular thrombus formation is a frequent finding in patients with anterior wall STEMI treated with acute PCI and dual antiplatelet therapy, especially in those with larger infarcts. In addition, an inflammatory response may be of importance for the formation of LV thrombus in these patients.
Disclosure of interest: none declared.
To cite this abstract use the following format:
Journal of Thrombosis and Haemostasis 2007; Volume 5, Supplement 2: abstract number
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