Primary angioplasty reduces the risk of left ventricular free wall rupture compared with thrombolysis in patients with acute myocardial infarction.
OBJECTIVE
This study aimed to evaluate the effect of primary angioplasty (PA) over the risk of free wall rupture (FWR) in reperfused acute myocardial infarction (AMI).


BACKGROUND
It has been suggested that PA reduces the risk of FWR compared with thrombolysis. However, few studies have evaluated this issue, and there are no data demonstrating this hypothesis.


METHODS
A total of 1,375 patients with AMI treated with PA (n = 762, 55.4%) or thrombolysis (n = 613, 44.6%) within 12 h after symptoms onset were included. The diagnosis of FWR was made either in the presence of sudden death due to electromechanical dissociation with large pericardial effusion on an echocardiogram or when demonstrated post mortem or at surgery. A multivariable analysis was performed including type of reperfusion strategy.


RESULTS
The overall incidence of FWR was 2.5% (n = 34): 1.8% and 3.3% in patients treated with PA and with thrombolysis, respectively (p = 0.686). The following characteristics were associated with a higher rate of FWR in the univariable analysis: age >70 (5.2% vs. 1.2%, p < 0.001), female gender (5.1% vs. 1.8%, p = 0.006), anterior location (3.3% vs. 1.4%, p = 0.020) and treatment >2 h after symptoms onset (3.6% vs. 1.7%, p = 0.043). In the multivariable analysis, age >70 (odds ratio [OR]: 4.12, 95% confidence interval [CI]: 2.04 to 8.62, p < 0.001) and anterior location (OR: 2.91, 95% CI: 1.36 to 6.63, p = 0.008) were independent risk factors of FWR, whereas treatment with PA was an independent protective factor (OR: 0.46, 95% CI: 0.22 to 0.96, p = 0.0371).


CONCLUSIONS
In patients with AMI, PA reduces the risk of FWR in comparison with thrombolysis.
Moreno
Raúl
R
Coronary Care Unit, Hospital Gregorio Marãón, Madrid, Spain. raulmorenog@terra.es
López-Sendón
José
J
García
Eulogio
E
Pérez de Isla
Leopoldo
L
López de Sá
Esteban
E
Ortega
Ana
A
Moreno
Mar
M
Rubio
Rafael
R
Soriano
Javier
J
Abeytua
Manuel
M
García-Fernández
Miguel-Angel
MA
D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003326:Coronary Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome; D018658:Ventricular Septal Rupture / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*