Effects of intravenous recombinant tissue-type plasminogen activator therapy on the incidence and associations of left ventricular thrombus in patients with a first acute Q wave anterior myocardial infarction.
Consecutive survivors of a first Q wave anterior myocardial infarction were studied to observe the impact of recombinant tissue-type plasminogen activator (rt-PA) therapy on the incidence and associations of left ventricular thrombus. Fifty-four patients received rt-PA within 4 hours after the onset of cardiac pain, followed by heparin infusion. Forty-four patients who did not qualify for rt-PA therapy but who were anticoagulated with heparin served as a control group. Two-dimensional echocardiography was performed in all patients on days 3 and 7 to detect thrombi and analyze wall motion. Ejection fraction was determined by radionuclide angiography in all patients on day 7. Apical thrombi were detected on day 3 in three patients (5.5%) who received rt-PA and in eight control patients (18%) (p less than 0.05). All patients with a thrombus had apical dyskinesis and 8 of 11 (73%) had an aneurysm. Of the 87 patients without thrombosis, apical dyskinesis and aneurysm were present in 42 (48%) and 11 (13%) patients, respectively (p less than 0.01). Ejection fractions and wall motion scores of patients without a thrombus were significantly better when compared with data from those with a thrombus. There were fewer patients with apical dyskinesis (17 of 54) in the group receiving rt-PA therapy compared with the control group (36 of 44) (p less than 0.01). Ejection fractions and wall motion scores were better in patients who received rt-PA compared with control subjects (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Bhatnagar
S K
SK
Faculty of Medicine, Kuwait University.
al-Yusuf
A R
AR
D004452:Echocardiography; D004562:Electrocardiography / Q000187:drug effects*; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D011446:Prospective Studies; D011875:Radionuclide Angiography; D011994:Recombinant Proteins / Q000008:administration & dosage; D013670:Sodium Pertechnetate Tc 99m; D013318:Stroke Volume; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
D011994:Recombinant Proteins; D013670:Sodium Pertechnetate Tc 99m; D010959:Tissue Plasminogen Activator