Myocardial Rupture Following PCI: Incidence, Diagnosis and Treatment

Abstract

Myocardial rupture (MR) is an infrequent but severe complication of percutaneous coronary intervention (PCI), occurring almost exclusively following ST-segment elevation myocardial infarction (STEMI) reperfusion procedures. MR can be classified into three categories according to its location: free wall rupture (FWR), ventricular septal rupture (VSR), or papillary muscle rupture (PMR). The frequency of MR shows two peaks: one early (within 24 h), and one late (from 3 to 5 days after symptom onset). MR is related to the evolution of intramyocardial hemorrhage, which dissects through myocardial necrosis toward the epicardial surface. The incidence rates of FWR and VSR range from 0.5% to 2.5% and from 0.2% to 4.6%, respectively, according to the series, but these percentages have decreased over time with the emergence of primary PCI as the preferential therapy for STEMI reperfusion. The diagnosis of MR relies on clinical and cardiac echocardiography findings. The prognosis remains severe, with high in-hospital mortality. Management should involve multidisciplinary teams to stabilize patients’ hemodynamics in order to propose them for surgical treatment. Percutaneous closure devices can be used as an alternative to surgery in cases of VSR.