Abstract 14271: Over 35 Years Trend in the Clinical and Pathological Characteristics of Cardiac Rupture in Patients With Acute Myocardial Infarction
Background: Early reperfusion by thrombolysis or primary percutaneous coronary intervention has improved the survival following acute myocardial infarction (AMI), in which cardiac rupture (CR) including free wall rupture and ventricular septal perforation is known as a catastrophic complication. However, little is known whether the incidence of CR or its clinical and pathological characteristics have changed over years under the medical progress for AMI.
Method: The present study included a total of 5699 consecutive AMI patients (male/female=4364/1335, age 66±12years) hospitalized between 1977 and 2011, who were divided into 3 groups in chronological order; 1st interval (n=1742; 1977 to 1989), 2nd interval (n=1919; 1990 to 2000) and 3rd interval (n=2038; 2001 to 2011). The incidence of CR and its clinical characteristics, as well as 64 autopsy cases with CR, were analyzed.
Results: Over 35 years, the incidence of all CR decreased (1st: 3.3%, 2nd: 2.8%, 3rd: 1.7%; P=0.01) in response to the progressive spread of reperfusion therapy (1st: 2%, 2nd: 48%, 3rd: 71%; P<0.001)(Figure A). In patients with CR, mortality rate decreased (1st: 90%, 2nd: 56%, 3rd: 50%; P<0.001) with increased rate of emergent surgery (1st: 26%, 2nd: 61%, 3rd: 68%; P<0.001)(Figure B). The proportion of blow-out rupture decreased (1st: 60%, 2nd: 33%, 3rd: 26%; P=0.002), whereas that of woozing rupture increased (1st: 5%, 2nd: 30%, 3rd: 33%; P=0.001). From autopsy cases with CR, the incidence of transmural myocardial infarction tended to decrease (1st: 77%, 2nd: 50%, 3rd: 43%; P=0.056), whereas myocardial hemorrhage at infracted area increased (1st: 23%, 2nd: 61%, 3rd: 57%; P=0.01).
Conclusions: Over the past several decades with the development of reperfusion therapy, the incidence of CR, especially blow-out rupture, and mortality rate of CR have decreased. Attenuating the reperfusion-induced myocardial hemorrhage might be a novel target in future adjunctive treatment of AMI.
- © 2013 by American Heart Association, Inc.