Changes in Hospital Mortality Rates in 425 Patients With Acute ST-Elevation Myocardial Infarction and Cardiac Rupture Over a 30-Year Period

Abstract

Background— Possible changes in the incidence and outcome of cardiac rupture in patients with ST-elevation myocardial infarction over a long period of time have not been investigated. Methods and Results— The incidence of cardiac rupture in ST-elevation myocardial infarction patients and its mortality rate were investigated during a 30-year period divided into 5 intervals (1977 to 1982, 1983 to 1988, 1989 to 1994, 1995 to 2000, and 2001 to 2006). Of a total of 6678 consecutive patients, 425 experienced a free wall rupture (280 with cardiac tamponade: 227 with electromechanical dissociation and 53 with hypotension) or a septal rupture (145). After the exclusion of referrals from other centers (n=44), the incidence of definite cardiac rupture (septal rupture, anatomic evidence of free wall rupture, or electromechanical dissociation) declined progressively (6.2% in 1977 to 1982 to 3.2% in 2001 to 2006; P <0.001) in parallel with a progressive use of reperfusion therapy (0% to 75.1%; P <0.001). In addition, among patients with cardiac rupture, there was a progressive fall in the rate of death (94% to 75%; P <0.001) despite a trend toward increasing age (66±8 to 75±8 years; P <0.054) in conjunction with better control of systolic blood pressure at 24 hours (130±24 versus 110±18 mm Hg; P <0.001); an increased use of reperfusion therapy (0% to 59%; P <0.001), β-blockers (0% to 45%; P <0.001), angiotensin-converting enzyme inhibitors (0% to 38%; P <0.001), and aspirin (0% to 96%; P <0.001); and a lower use of heparin (99% to 67%; P <0.001). Conclusion— The decline in the incidence in cardiac rupture and its rate of death over the last 30 years appears to be associated with the increasing use of reperfusion strategies and adjunct medical therapy.