Cardiac rupture risk estimation in patients with acute myocardial infarction treated with percutaneous coronary intervention

Abstract

Background: Cardiac rupture (CR) is a common cause of death following acute myocardial infarction (AMI). Despite improvements in AMI treatment, the frequency of CR remains considerable and in most cases leads to death. The aim of the study was to define the independent prognostic CR risk factors of AMI in patients treated with percutaneous coronary intervention (PCI).
Methods: A total of 4,200 AMI patients treated by PCI were studied retrospectively. Two hundred and seventy patients who had died of AMI were examined. In all cases CR was confirmed in post-mortem examination. Results: Cardiac rupture occurred in 49 patients (18.1%). In the CR group, 24.4% patients received thrombolysis and 22.6% in the non-CR group (p = NS). The following characteristics were associated with a higher rate of CR in univariable analysis: age (70.3 ± 3.2 vs. 65.2 ± ± 9.9; p < 0.001), female (75.0% vs. 60.2%; p < 0.001), prior cardiac event and absence of myocardial infarction history (61.2% vs. 40.2%; p < 0.05 and 14.2% vs. 33.4%; p < 0.05), presence of QS complex in first ECG (75.5% vs. 52.0%, p < 0.05) and multiple coronary heart disease (75.5% vs. 61.5%, p < 0.05), and long time from onset of symptoms to thrombolysis and to PCI (8.1 ± 2.8 vs. 4.7 ± 2.3 hours, p < 0.001 and 9.0 ± 5.5 vs. 4.5 ± 3.2 hours, p < 0.001). In the multivariable analysis, independent predictors of CR were: age (OR: 1.1; 95% CI: 1.02-1.19; p = 0.01); female gender (OR: 0.2; 95% CI: 0.07-0.52; p = 0.001); time from onset of symptoms to PCI (OR: 1.15; 95% CI: 1.07-1.47; p = 0.003).
Conclusions: Old age, female gender and long time from onset of symptoms to AMI treatment (independent of previous fibrinolysis) are independent factors of CR in PCI patients. (Cardiol J 2007; 14: 538-543).