Risk of cardiac rupture after acute myocardial infarction is related to a risk of hemorrhage

Abstract

Although cardiac rupture (CR) is a fatal mechanical complication of acute myocardial infarction (AMI), to date no predictive model for CR has been described. CR has common pathological characteristics with major bleeding. We aimed to investigate the relationship between the risk factors of major bleeding and CR. A total of 10202 consecutive AMI patients were recruited, and mechanical complications occurred in 72 patients. AMI patients without CR were chosen as control group. Clinical characteristics including bleeding-related factors were compared between the groups. The incidences of free wall rupture (FWR), ventricular septal rupture (VSR), and papillary muscle rupture (PMR) were 0.39%, 0.21%, and 0.09%, respectively, and the hospital mortalities were 92.5%, 45.5%, and 10.0%, respectively. Female proportion and average age were significantly higher in the groups of FWR and VSR than in the control group (P<0.01); higher white blood cell count and lower hemoglobin were found in all CR groups (P<0.01). Compared to the control group, patients with CR were more likely to receive an administration of thrombolysis [26.39% vs. 13.19%, P<0.05], and were less likely to be treated with primary percutaneous coronary intervention (PCI) [41.67% vs. 81.60%, P<0.05]. The major bleeding scores (integer scores) of FWR, VSR, and PMR were (17.70±7.24), (21.91±8.33), and (18.60±7.88), respectively, and were significantly higher than that of the control group (11.72±7.71) (P<0.05). A regression analysis identified age, increased heart rate, anemia, higher white blood cell count, and thrombolysis as independent risk factors of CR, most of which were major bleeding-related factors. The patients with CR have a significantly higher risk of hemorrhage compared to the group without CR. Risk of CR after AMI is related to the risk of hemorrhage.

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

“…Pericardial effusion was also independently correlated with anemia in our study. In our previous research, we have indicated that risk of CR after AMI was related to the risk of hemorrhage (Qian et al, 2013). Hemorrhage of the myocardium often leads to hemoglobin level decline and bloody pericardial effusion, which could explain why anemia was closely associated 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

“…[ 17 , 22 , 24 ] Nevertheless, in a study of 10,202 patients in China with acute myocardial infarction, female sex did not remain as a significant factor in the multivariate regression model when other factors were adjusted for. [ 25 ] Further studies are required to delineate the association between sex and VFWR in different populations.…”

Retracted: IRAK3 gene silencing prevents cardiac rupture and ventricular remodeling through negative regulation of the NF‐κB signaling pathway in a mouse model of acute myocardial infarction

“…Although a decreased mortality rate has been revealed in patients with AMI after effective therapeutic methods such as PCI, left ventricular remodeling, following myocardial infarction (MI), inevitably occurs with cardiovascular disability and death (Han et al, ). Additionally, cardiac rupture is a prevalent and fatal complication of AMI accompanied by common clinicopathological features with major bleeding (Qian, Liu, Wang, Wu, & Chen, ). Cardiac rupture results from local hyperergic inflammation, whereas cardiac dysfunction following MI manifests itself as a major consequence of cardiac fibrosis and a massive myocardial cell loss (Peng et al, ).…”