Abstract
BackgroundCardiac rupture (CR) is a fatal complication of ST-elevation myocardial infarction (STEMI) with its incidence markedly declined in the recent decades. However, clinical features of CR patients now and the effect of reperfusion therapy to CR remain unclear. We investigated the clinical features of CR in STEMI patients and the effect of reperfusion therapy to CR in mice.MethodsTwo studies were conducted. In clinical study, data of 1456 STEMI patients admitted to the First Hospital, Xi’an Jiaotong University during 2015.12. ~ 2018.12. were analyzed. In experimental study, 83 male C57BL/6 mice were operated to induce MI. Of them, 39 mice were permanent MI (group-1), and remaining mice received reperfusion after 1 h ischemia (21 mice, group-2) or 4 h ischemia (23 mice, group-3). All operated mice were monitored up to day-10. Animals were inspected three times daily for the incidence of death and autopsy was done for all mice found died to determine the cause of death.ResultsCR was diagnosed in 40 patients: free-wall rupture in 17, ventricular septal rupture in 20, and combined locations in 3 cases. CR presented in 19 patients at admission and diagnosed in another 21 patients during 1 ~ 14 days post-STEMI, giving an in-hospital incidence of 1.4%. The mortality of CR patients was high during hospitalization accounting for 39% of total in-hospital death. By multivariate logistic regression analysis, older age, peak CK-MB and peak hs-CRP were independent predictors of CR post-STEMI. In mice with non-reperfused MI, 17 animals (43.6%) died of CR that occurred during 3–6 days post-MI. In MI mice received early or delayed reperfusion, all mice survived to the end of experiment except one mouse died of acute heart failure.ConclusionCR remains as a major cause of in-hospital death in STEMI patients. CR patients are characterized of being elderly, having larger infarct and more server inflammation. Experimentally, reperfusion post-MI prevented CR.
Highlights
Cardiac rupture (CR) is a fatal complication of ST-elevation myocardial infarction (STEMI) with its incidence markedly declined in the recent decades
Cardiac rupture (CR) consists of free wall rupture (FWR) and ventricular septum rupture (VSR), and is a lethal mechanical complication of acute myocardial infarction (MI) [1], the incidence of CR was between 7 to 20% in ST-elevation MI (STEMI) patients during 1970s to 1990s [2, 3], when CR was reported to occur either early after the onset of MI or during the sub-acute phase accompanied with overt cardiac remodeling [3]
2568 patients were excluded according to the exclusion criteria and the remaining 1456 patients with confirmed STEMI diagnosis were included in this retrospective study
Summary
Cardiac rupture (CR) is a fatal complication of ST-elevation myocardial infarction (STEMI) with its incidence markedly declined in the recent decades. We investigated the clinical features of CR in STEMI patients and the effect of reperfusion therapy to CR in mice. Current literature indicates that CR remains as an emergency of modern cardiology contributing to the total in-hospital mortality in MI patients [3]. It is unclear on the clinical features of CR in the era of reperfusion therapy, a knowledge essential for the evaluation and timely intervention of CR events and preventive procedures. The aim of this study was to investigate the incidence, associated risk factors, timing of occurrence, and clinical outcomes of this complication in acute MI patients in the PCI era and influence of reperfusion in MI mice
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