Abstract 11853: Clinical Manifestation of Early Phase Left Ventricular Rupture Complicating Acute Myocardial Infarction in the Primary PCI Era
Background: Before reperfusion therapy was introduced, the incidence of ventricular septal and left ventricular free wall rupture complicating acute myocardial infarction (AMI) was 1% to 3%. In cases of ST-elevation acute coronary syndrome, those presented whithin 12 hours from their symptom onset should be treated by primary PCI. Primary PCI was expected to reduce the incidence of such mechanical complication.
Methods and Results: We retrospectively analyzed 1,284 AMI patients referred to our institute during January 2005 to January 2011. Primary PCI was done in 1002 cases of the study patients (77.8%). Ventricular septal rupture (VSR) occurred in 19 cases (1.5%) and left ventricular free wall rupture (LVFR) in 17 cases (1.3%). Mean observation periods from onset to VSR and LVFR was 2.6 days. Multiple regression analysis revealed that risk factors of VSR were advanced age, female sex, absence of history of angina or myocardial infarction, absence of hypertension or diabetes mellitus. Coronary angiography revealed that the culprit lesions were total occulsion of the left anterior descending artery in 12 of the VSR cases (60%) and 12 of the LVFR cases (70.6%). Furthermore, 6 of the VSR cases (33.3%) and 2 of the LVFR cases (11.8%) occurred within 6 hours from the onset of AMI. Although surgical repair was performed in 79% of the VSR cases and 53% of the LVFR cases, in-hospital mortality rate was still high (68.4% in the VSR cases and 82.4% in the LVFR cases). If patients developed total occulusion of left anterior descending artery (TIMI0) without history of prior myocardial infarction or multivessel stenosis, it is estimated that 11.0% (21/191) patients developed mechanical complication such as VSR and LVFR.
Conclusions: Even in the patients’ cohort with higher prevalence of primary PCI, left ventricular rupture cases were not decreased in contrast to our expectation. More attention should be paind for early left ventricular rupture cases whithin 6 hours from symptom onset in those cases.
- © 2011 by American Heart Association, Inc.