A real-world analysis of cardiac rupture on incidence, risk factors and in-hospital outcomes in 4190 ST-elevation myocardial infarction patients from 2004 to 2015

Abstract

Background Cardiac rupture is a disastrous but uncommon complication of acute ST-elevation myocardial infarction (STEMI). The incidence, risk factors and in-hospital outcomes related to cardiac rupture in the current era are unknown. Methods This study consecutively collected all acute STEMI patients admitted to a single tertiary center in China from January 2004 to December 2015. Characteristics of each cardiac rupture were collected and analyzed. Results Among 4190 patients, 75 (1.8%) patients had cardiac rupture, including 33 at the ventricular septum and 42 at the left ventricle free wall (LVFW). Patients with cardiac rupture were more likely to be female, with more advanced age, lower rate of primary percutaneous coronary intervention (PPCI), and higher in-hospital mortality. Compared with survivors, the death cases were older, had a higher white blood cell count, higher rate of delayed admission (>12 h from symptom onset to door), earlier occurrence of cardiac rupture, higher percentage of LVFW rupture and lower rate of surgical repair. Logistic regression analysis showed that surgical repair served as the most valuable factor affecting survival. Moreover, elevated white blood cell count and advanced age might be related to an increased in-hospital death due to cardiac rupture. Conclusions In this contemporary cohort, female sex, advanced age and low rate of PPCI post-STEMI are associated with an increased risk of cardiac rupture. Advanced age and elevated white blood cell count might be related to an increased in-hospital mortality after cardiac rupture, whereas surgical repair served as the most valuable factor affecting survival.

Percutaneous Closure of Post Myocardial Infarction Ventricular Septal Rupture in an Unstable Hemodynamic State, Using an Unconventional Internal Jugular venous access;

“…The cardiac rupture can induce heart failure and even cardiogenic shock by shunt formation (9). Based on Ziyong Hao and et al's study, about 89% of patients with cardiac rupture dies in-hospital (7). Despite a significant decline in the mortality rate of patients with MI without VSR during the past decade, there is still a high mortality rate among patients with MI and VSR (7).…”

“…Based on Ziyong Hao and et al's study, about 89% of patients with cardiac rupture dies in-hospital (7). Despite a significant decline in the mortality rate of patients with MI without VSR during the past decade, there is still a high mortality rate among patients with MI and VSR (7). VSR occurs more likely in the necrotic part of the heart within 2-8 days after infarction (3).…”

Left ventricular free wall rupture: A real nightmare

“…2 The mortality rate for LVFWR is said to be from 75% to 90% and it is the cause for 20% of in-hospital deaths after AMI. 3 Emergency surgery is indicated and normally the rupture site is easily identified, but it may not be macroscopically apparent, corresponding to transmyocardial or subepicardial dissection with an external rupture far from the infarction site, or already thrombosed and contained. 1 Repair of the ventricular wall is usually achieved either by suturing the edges of the tear or closing it with large patches of synthetic materials (dacron, Teflon, etc.)…”

Survival after left ventricular free wall rupture following acute myocardial infarction by conservative treatment

“…Cardiac rupture is a rare but fatal complication of AMI. It accounts for approximately 20% of STEMI patient in-hospital deaths [1]. The three types of cardiac rupture are ventricular septal rupture, free-wall rupture, and papillary muscle rupture.…”