title: Primary angioplasty reduces the risk of left ventricular free wall rupture compared with thrombolysis in patients with acute myocardial infarction.
abstract: 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.
authors.affiliation: Coronary Care Unit, Hospital Gregorio Marãón, Madrid, Spain. raulmorenog@terra.es
authors.forename: Raúl
authors.initials: R
authors.lastname: Moreno
authors.forename: José
authors.initials: J
authors.lastname: López-Sendón
authors.forename: Eulogio
authors.initials: E
authors.lastname: García
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Pérez de Isla
authors.forename: Esteban
authors.initials: E
authors.lastname: López de Sá
authors.forename: Ana
authors.initials: A
authors.lastname: Ortega
authors.forename: Mar
authors.initials: M
authors.lastname: Moreno
authors.forename: Rafael
authors.initials: R
authors.lastname: Rubio
authors.forename: Javier
authors.initials: J
authors.lastname: Soriano
authors.forename: Manuel
authors.initials: M
authors.lastname: Abeytua
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: García-Fernández
mesh_terms: 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*