[Heart rupture in acute myocardial infarction: multicenter observational study of the coronary unit of Piedmont].
BACKGROUND
The aim of this study was to prospectively evaluate the incidence of cardiac rupture during myocardial infarction (MI) as well as the predictive value of the main cardiac rupture risk factors.


METHODS
The study was carried out in 17 coronary care units (CCU) between January and December 1999 in the Piedmont region (Italy).


RESULTS
The incidence of cardiac rupture was 1.4% of the total number of MI (n = 3041). Data from 13 out of 17 CCU showed the following causes of death during MI: 66% heart failure, 16% cardiac rupture, 7% arrhythmias, 11% others. Twenty-seven percent out of 44 cardiac ruptures had prior angina, 9% prior MI; 24% of patients were diabetic; 38% had anterior wall MI; 62% infero-postero-lateral MI; 86% showed ST-segment elevation, and 79.5% developed Q waves. Thrombolysis was administered in 39% of cases. Forty-three percent cardiac ruptures occurred within 24 hours. Electromechanical dissociation was present in 73% of cases, syncope and hypotension in 43%, bradycardia in 30%. An echocardiogram was performed in 89% of cases in the suspicion of cardiac rupture but only 45% showed severe pericardial effusion. One patient was referred to surgery but he died in the postoperative period. Autoptical diagnosis was made in 32% of cases. All patients died. The analysis of some qualitative variables (gender, thrombolysis, MI localization, ST-segment/non-ST-segment elevation) in 8 out of 17 CCU, between the cardiac rupture group (n = 22) and the MI group (n = 1330) showed a significant result only for the female gender.


CONCLUSIONS
Cardiac rupture is the second cause of death during MI after heart failure; there is a higher incidence of cardiac rupture in infero-postero-lateral MI, after the first 24 hours particularly in the female gender; there is a low global incidence (1.4%).
Pron
Paolo Giay
PG
Scuola di Specializzazione in Malattie Cardiovascolari, Università degli Studi, Torino.
Angelino
Paolo
P
Varbella
Ferdinando
F
Bongioanni
Sergio
S
Masi
Andrea Sibona
AS
Iazzolino
Ernesto
E
Bonfiglio
Giovanna
G
Brusin
Maria Cristina Rosa
MC
Mainardi
Loredana
L
Nicastro
Cristina
C
Bouslenko
Zoe
Z
Conte
Maria Rosa
MR
D003325:Coronary Care Units; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007558:Italy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
Rottura di cuore nell'infarto miocardico acuto: studio multicentrico osservazionale delle unità coronariche piemontesi.