Predictive factors of cardiac rupture in patients with ST-elevation myocardial infarction

Abstract

Cardiac rupture (CR) is a potentially fatal mechanical complication of ST-elevation myocardial infarction (STEMI). We aimed to determine the incidence and risk factors of CR in Chinese STEMI patients. A total of 9798 consecutive STEMI patients from four centers in China were retrospectively analyzed, among which 178 patients had CR. STEMI patients without CR were chosen as a control group. Clinical characteristics were compared between STEMI patients with CR and those without CR. The incidence of CR in STEMI patients was 1.82%, and the 30-d mortality was up to 61.2%. CR patients were significantly older, more female, and associated with a longer time from onset of pain to hospital admission than their non-CR counterparts (P<0.001). More patients with anterior myocardial infarction (82.1%) were found in the CR group, and CR patients had significantly higher heart rates than the control group ((91±19) bpm vs. (71±16) bpm; P<0.001). In multiple-adjusted models, the independent risk factors of CR were advanced age, female gender, anaemia, increased heart rate, anterior myocardial infarction, increased white blood cell (WBC) count, delayed admission, and renal dysfunction. The level of hemoglobin remained a significant determinant factor of CR (OR (95% CI): 0.82 (0.75-0.89); P<0.001) after adjusting for various potential confounding factors. Counts of WBC also remained a significant determinant of the CR (OR (95% CI): 1.08 (1.04-1.12); P<0.001). A number of variables were independently related to CR. This study indicated, for the first time, that both hemoglobin and WBC levels were independently correlated with occurrence of CR.

Comparison of the risk of left ventricular free wall rupture in Taiwanese patients with ST-elevation acute myocardial infarction undergoing different reperfusion strategies

“…Old age has been consistently reported as a risk factor for VFWR in many previous reports. [ 21 – 23 ] On the contrary, female sex did not emerge as a significant independent predictor for VFWR in our study. Several studies have shown higher incidences of VFWR in women even without thrombolytic therapy.…”

Inflammatory markers in ST-elevation acute myocardial infarction

“…An increase in white blood cell count (leukocytosis) is associated with increased mortality during AMI and represents an independent prognostic factor to develop HF and cardiogenic shock. 26–29 The TIMI10A and TIMI10B trials involving approximately 1000 patients with STEMI (reperfused by fibrinolytic therapy) showed an independent association between leukocytosis and failure of reperfusion, thrombus resistance, incidence of HF and death. 30 A substudy of the more recent HORIZONS-AMI trial involving approximately 3000 patients with STEMI undergoing primary percutaneous coronary intervention (PCI) observed an independent association between leukocytosis, infarct size and 1 year mortality.…”

Treatment strategies for post-infarction left ventricular free-wall rupture

“…Left ventricular free-wall rupture (LVFWR) may represent a dramatic and life-threatening event, occurring in up to 2% of patients with acute myocardial infarction (AMI). 1,2 The clinical presentation varies from a catastrophic blowout type characterized by cardiogenic shock and eventually cardiac arrest, to the oozing type with haemodynamic instability and pericardial effusion. 3 Prompt diagnosis and management can lead to successful treatment for LVFWR.…”