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Purpose: Left ventricular thrombosis (LVT) is an acute myocardial infarction (AMI) complication with a high risk of systemic ischaemic event and an incidence highly variable in literature, from 3% to 50%. A reduction of LVT has been described in the fibrinolytic era. It's less known the impact on LVT of primary angioplasty and dual antiplatelet therapy in the acute phase of AMI.Methods: 453 consecutive pts with ST elevation myocardial infarction (STEMI), revascularized with primary PCI and BMS were included. All were treated with aspirin 250 mg and clopidogrel 600 the first day and then 100 mg/day and 75 mg/day respectively. They underwent serial echocardiogram during the in-hospital follow up (day 6-14, median 8 days). The ejection fraction and infarct size with WMSI and peak CKMB and troponin were calculated. The role of thrombotic risk factors as diabetes, renal insufficiency, atrial fibrillation, hyperomocysteinemia was evaluated.Results: LVT was detected in 8 patients, all with anterior MI, all males, 1,8% of total and 3,7% of anterior MI. Except for male sex, no significant differences in baseline characteristics between the groups with and without LV thrombi were found. At linear regression no significant difference in the incidence of atrial fibrillation, diabetes or cronic renal insufficiency was found. However, comparing only anterior MI, in the thrombus group were found significantly higher peak CPKMB levels (268 vs 158 ng/ml, p < 0.03), larger infarct sizes (WMSI 1,79 vs 1,36 p <0.01), and lower ejection fractions (39,5% vs 46.0%, p< 0.001) compared to patients without LV thrombi. The incidence of LVT was significantly lower in our primary PCI pts compared with data of the fibrinolitic era (3,7% vs 27% in the GISSI2 cohort) and aggressive dual antiplatet therapy may play a role.Conclusions: LV thrombus formation is a less frequent finding in patients with STEMI treated acutely with PCI and dual-antiplatelet therapy. Only large anterior MI pts, are at risk and they should be studied with serial echocardiography.