The impact of a previous history of ischaemic episodes on the occurrence of left ventricular free wall rupture in the setting of myocardial infarction

Abstract

Background: Ischaemic episodes preceding myocardial infarction (MI) are one of the defence mechanisms protecting the body from the consequences of sudden ischaemia. Left ventricular free wall rupture (LVFWR) is a rare complication of MI but leading, in a majority of patients, to sudden cardiac death.

Aim: To assess the impact of a previous history of ischaemic episodes (IEs) on the occurrence of LVFWR in patients with acute MI (AMI) managed by percutaneous coronary intervention (PCI).

Methods: The study population consisted of 270 patients who had died during hospitalisation for AMI. All the patients were managed by PCI. The study group (the LVFWR group) consisted of 49 patients who developed LVFWR during hospitalisation and the control group (the non-LVFWR group) consisted of the remaining 221 patients who had died from causes other than LVFWR. In all the patients with LVFWR the rupture was confirmed by autopsy. The data on AMI was obtained from history or medical records. The data on IEs was obtained on the basis of the symptoms that were reported by the patients in the past that directly preceded the most recent AMI or on the basis of medical records.

Results: Compared to the non-LVFWR group the LVFWR group was characterised by an older age (70.3 ± 3.4 vs. 65.2 ± 9.9 years, p < 0.001) and a higher percentage of females (75.0% vs. 60.2%, p < 0.001). The LVFWR group was also characterised by a higher percentage of IEs in the past (61.2% vs. 40.2%, p = 0.003), a lower percentage of patients with a history of MI (14.2% vs. 33.4%, p = 0.004), a higher percentage of patients with multivessel coronary artery disease (77.5% vs. 61.5%, p = 0.03), a longer interval from the onset of symptoms to PCI (9.0 ± 5.5 vs. 4.5 ± 3.2 h, p < 0.001) and a lower percentage of patients with IEs in the past but without an MI (6.1% vs. 23.9%, p < 0.001). Our study showed that independent risk factors for LVFWR in the setting of AMI were: older age (OR 1.1, 95% CI 1.02–1.19), male sex (OR 0.2, 95% CI 0.07–0.52) and a longer interval between the onset of symptoms and PCI (OR 1.25, 95% CI 1.07–1.47).

Conclusions: A previous history of IEs in patients without a previous history of AMI was a protective factor against the development of LVFWR in the setting of AMI.