Cardiac rupture complicating acute myocardial infarction: the clinical features from an observational study and animal experiment

Abstract

Background. Cardiac rupture (CR) is a fatal complication of ST-elevation myocardial infarction (STEMI) with its incidence markedly declined in the recent decades. However, clinical features of CR patients now and the effect of reperfusion therapy to CR remain unclear. We investigated the clinical features of CR in STEMI patients and the effect of reperfusion therapy to CR in mice.Methods. Two studies were conducted. In clinical study, data of 1456 STEMI patients admitted to the First Hospital, Xi'an Jiaotong University during 2015.12.~2018.12. were analyzed. In experimental study, 83 male C57BL/6 mice were operated to induce MI. Of them, 39 mice were permanent MI (group-1), and remaining mice received reperfusion after 1 h ischemia (21 mice, group-2) or 4 h ischemia (23 mice, group-3). All operated mice were monitored up to day-10. Animals were inspected three times daily for the incidence of death and autopsy was done for all mice found died to determine the cause of death. Results. CR was diagnosed in 40 patients: free-wall rupture in 17, ventricular septal rupture in 20, and combined locations in 3 cases. CR presented in 19 patients at admission and diagnosed in another 21 patients during 1~14 days post-STEMI, giving an in-hospital incidence of 1.4%. The mortality of CR patients was high during hospitalization accounting for 39% of total in-hospital death. By multivariate logistic regression analysis, older age, peak CK-MB and peak hs-CRP were independent predictors of CR post-STEMI. In mice with non-reperfused MI, 17 animals (43.6%) died of CR that occurred during 3-6 days post-MI. In MI mice received early or delayed reperfusion, all mice survived to the end of experiment except one mouse died of acute heart failure.Conclusion. CR remains as a major cause of in-hospital death in STEMI patients. CR patients are characterized of being elderly, having larger infarct and more server inflammation. Experimentally, reperfusion post-MI prevented CR.

Risk factors for cardiac rupture after acute ST-segment elevation myocardial infarction during the percutaneous coronary intervention era: a retrospective case-control study

“…The early myocardial hemorrhage in CR often leads to a decrease in hemoglobin level (28). In this study, the levels of CK, CK-MB, and NT-proBNP in patients with CR were higher than the control group, which was similar to the results of Lu et al (5), and may be due to the release of more cardiac enzymes, poorer cardiac function, and larger infarct area in patients with CR. Patients in the CR group who underwent emergency PCI had more complex lesions and lower preoperative and postoperative TIMI blood flow grades than the control group, which was similar to the conclusions of Rencuzogullari et al (29).…”

“…Therefore, the early and accurate identification and prevention of possible CR is of great importance. Previous studies found older age, female, lower LVEF, hyperglycemia, and thrombocytopenia were risk factors for CR after AMI (3)(4)(5)(6). These factors were lack of specificity, which often occur in other diseases.…”

Neutrophil percentage‐to‐albumin ratio and monocyte‐to‐lymphocyte ratio as predictors of free‐wall rupture in patients with acute myocardial infarction

“…NPAR, composed of neutrophil percentage and albumin, represents two different mechanisms that lead to FWR, and there may be a synergistic effect between them. After the occurrence of AMI, the ischemic myocardial cells are extensively necrotic, which leads to severe inflammatory reaction 19 . Necrotic cardiomyocytes and matrix fragments activate complement amplification cascade reaction and Toll‐IL‐1 receptor pathway, and then nuclear factor (NF)‐κB is activated to induce the secretion of chemokines, cytokines, and adhesion molecules, which leads to neutrophil infiltration 20 .…”