Abstract 16619: Fatal Cardiac Rupture After Myocardial Infarction in the Modern Era: A Study of 187 Autopsy Cases With Correlation of Clinical and Pathologic Findings
Context: Cardiac rupture is a common cause of sudden death after myocardial infarction (MI). Although this dreaded complication was characterized decades ago, contemporary studies are few, and have relied on clinical evidence of rupture, rather than autopsy confirmation. Little is known about the clinicopathologic characteristics of cardiac rupture as it occurs in the modern treatment era. Design: All autopsy-confirmed cases of MI with fatal cardiac rupture (1986-2012) were identified in the institutional pathology database. Available clinical history and autopsy reports were reviewed.
Results: 187 decedents (mean age 74 ± 10 yrs, range 40-103 yrs, 96 men) were identified. Chest pain (70%) and out-of-hospital cardiac arrest (46%) were the most frequent presentations. Cardiac risk factors included age ≥ 60 years old (91%), hypertension (62%), tobacco smoking (33%), and diabetes mellitus (23%). Prior MI was uncommon (13%). Clinically, the anteroseptal wall was the most common site of infarction (41%), followed by inferior (33%) then lateral (26%) walls. In contrast, ruptures at autopsy most frequently involved the inferior wall (33%), followed by anterior (31%) and lateral (27%) walls, usually at mid-ventricular level (62%) and at the periphery of the infarct (63%). Wall thinning was sometimes present (30%). Mean rupture size at the epicardial surface was 1.8 ± 1.1 cm. Histologically, mean infarct age was 4.8 ± 3.3 days. Septal ruptures occurred in 17% of cases, often as a component of an anterior or inferior free wall rupture, but occasionally in isolation without a free wall component (4%). Papillary muscle rupture occurred in 4%.
Conclusion: In contrast to older reports, fatal cardiac rupture after MI in the modern era is most common in elderly, hypertensive men, and most commonly involves the inferior wall and middle third of the left ventricle. There is discordance between the clinical site of infarction and the site of rupture at autopsy.
- © 2013 by American Heart Association, Inc.