Affiliation:
1. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan
2. Department of Advanced Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan
3. Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Hospital, Suita, Japan
4. Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
Abstract
Background
There is little known about whether the clinical and pathological characteristics and incidence of cardiac rupture (
CR
) in patients with acute myocardial infarction (
AMI
) have changed over the years.
Methods and Results
The incidence and clinical characteristics of
CR
were investigated in patients with
AMI
, who were divided into 3 cohorts: 1977–1989, 1990–2000, and 2001–2011. Of a total of 5699 patients, 144 were diagnosed with
CR
and 45 survived. Over the years, the incidence of
CR
decreased (1977–1989, 3.3%; 1990–2000, 2.8%; 2001–2011, 1.7%;
P
=0.002) in association with the widespread adoption of reperfusion therapy. The mortality rate of
CR
decreased (1977–1989, 90%; 1990–2000, 56%; 2001–2011, 50%;
P
=0.002) in association with an increase in the rate of emergent surgery. In multivariable analysis, first myocardial infarction, anterior infarct, female sex, hypertension, and age >70 years were significant risk factors for
CR
, whereas impact of hypertension on
CR
was weaker from 2001 to 2011. Primary percutaneous coronary intervention (
PPCI
) was a significant protective factor against
CR
. In 64 autopsy cases with
CR
, myocardial hemorrhage occurred more frequently in those who underwent
PPCI
or fibrinolysis than those who did not receive reperfusion therapy (no reperfusion therapy, 18.0%; fibrinolysis, 71.4%;
PPCI
, 83.3%;
P
=0.001).
Conclusions
With the development of medical treatment, the incidence and mortality rate of
CR
have decreased. However, first myocardial infarction, anterior infarct, female sex, and old age remain important risk factors for
CR
. Adjunctive cardioprotection against reperfusion‐induced myocardial hemorrhage is emerging in the current
PPCI
era.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
101 articles.
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