Abstract 13015: The Incidence, Characteristics, And Outcome Of Cardiac Rupture In Patients With Acute Myocardial Infarction In The Primary PCI Era
Background: Despite the outcome of acute myocardial infarction (AMI) has been improved with the reperfusion strategy, the morbidity and mortality after AMI still remain significant. In-hospital mortality in patients with AMI is predominantly related to heart failure or shock and mechanical complications like cardiac rupture. Cardiac rupture is uncommon but a lethal complication of AMI, and responsible for 10% to 20% of in-hospital deaths of patients with AMI. Despite cardiac rupture is still serious complication of AMI, the incidence, patient characteristics, and outcome of cardiac rupture due to AMI undergoing primary PCI have not been fully elucidated. The aim of this study was to reveal the clinical characteristics of AMI patients who underwent primary PCI and were complicated by cardiac rupture after hospital admission between April 2000 and June 2013.
Methods and Results: Of the consecutive 1,802 AMI patients (1,376 male and 426 female) transferred to our hospital and underwent primary PCI in this period. The incidence of cardiac rupture after hospital admission was 1.2% in all AMI patients undergoing primary PCI. The clinical characteristics of the patients with cardiac rupture included the higher age, female gender, Killip 4 classification, and delayed admission compared with those without rupture, however, no difference was found in culprit lesion in LAD. In-hospital mortality of cardiac rupture was 71.4%, and it was responsible for 18.1% of all cause of death of patients with AMI. Sixty-four percent of cardiac rupture occurred within 24 hours after hospital admission, and the mortality of these patients was very high (93%). Free wall rupture accounted for 95% of cardiac rupture in this study, only one ventricular septum perforation (5%). By multivariable analysis, female gender (OR 3.01) and Killip 4 classification (OR 5.38) were significant factors being associated with cardiac rupture.
Conclusion: Even in the era of primary PCI, cardiac rupture is a serious complication of AMI. It is necessary to follow the course of patients with AMI carefully, those with advanced age, female gender, Killip 4, and delayed admission.
- © 2013 by American Heart Association, Inc.