Effect of reperfusion therapy on cardiac rupture after myocardial infarction in Japanese.
BACKGROUND
Cardiac rupture after acute myocardial infarction (AMI) is unpredictable and almost always fatal, so the present study reviewed all the clinical characteristics of patients with cardiac rupture to determine if its occurrence can be predicted.


RESULTS
The clinical characteristics of 1,296 consecutive AMI patients from January 1992 to February 2002 were retrospectively evaluated using multi-logistic analysis. Cardiac rupture occurred in 45 patients (3.5%), comprising left ventricular free wall rupture (n=23), ventricular septal perforation (n=20) and papillary muscle rupture (n=2). Early-phase rupture (within 72 h after AMI onset) was associated with anterior infarction. Of the 45 patients who experienced ruptures, 24 (53.3%) survived to discharge; 21 (46.6%) of the 45 ruptures occurred after admission. Successful reperfusion therapy was performed within 24 h for 840 patients. The incidence of rupture was significantly lower for reperfused patients than for non-reperfused patients (0.6% vs 3.5%, respectively; p<0.01). Peak C-reactive protein concentration was a reliable predictor of late-phase rupture (p=0.01), but not of early-phase rupture.


CONCLUSIONS
Reperfusion therapy appears to aid in the prevention of cardiac rupture, especially late-phase rupture.
Ikeda
Nahoko
N
Cardiovascular Division, First Department of Integrated Medicine, Omiya Medical Center, Jichi Medical School, Saitama, Japan.
Yasu
Takanori
T
Kubo
Norifumi
N
Hirahara
Taishi
T
Sugawara
Yoshitaka
Y
Kobayashi
Nobuhiko
N
Hashimoto
Shigemasa
S
Tsuruya
Yoshio
Y
Fujii
Mikihisa
M
Saito
Muneyasu
M
D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000628:therapy*; D015425:Myocardial Reperfusion; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
D002097:C-Reactive Protein