Factors related to heart rupture in acute coronary syndromes in the Global Registry of Acute Coronary Events.
OBJECTIVE
To determine the incidence and factors associated with heart rupture (HR) in acute coronary syndrome (ACS) patients.


RESULTS
Among 60 198 patients, 273 (0.45%) had HR (free wall rupture, n = 118; ventricular septal rupture, n = 155). Incidence was 0.9% for ST-segment elevation myocardial infarction (STEMI), 0.17% for non-STEMI, and 0.25% for unstable angina. Hospital mortality was 58 vs. 4.5% in patients without HR (P < 0.001). The incidence was lower in STEMI patients with primary percutaneous coronary intervention (PCI) than in those without (0.7 vs. 1.1%; P = 0.01), but primary PCI was not independently related to HR in adjusted analysis (P = 0.20). Independent variables associated with HR included: ST-segment elevation (STE)/left bundle branch block; ST-segment deviation; female sex; previous stroke; positive initial cardiac biomarkers; older age; higher heart rate; systolic blood pressure/30 mmHg decrease. Conversely, previous MI and the use of low-molecular-weight heparin and beta-blockers during first 24 h were identified as protective factors for HR.


CONCLUSIONS
The incidence of HR is low in patients with ACS, although its incidence is probably underestimated. Heart rupture occurs more frequently in ACS with STE and is associated with high hospital mortality. A number of variables are independently related to HR.
Cardiology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28036 Madrid, Spain. jlsendon@terra.es
José
J
López-Sendón
Enrique P
EP
Gurfinkel
Esteban
E
Lopez de Sa
Giancarlo
G
Agnelli
Joel M
JM
Gore
Phillippe Gabriel
PG
Steg
Kim A
KA
Eagle
Jose Ruiz
JR
Cantador
Gordon
G
Fitzgerald
Christopher B
CB
Granger
D054058:Acute Coronary Syndrome / Q000150:complications* / Q000401:mortality / Q000628:therapy; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000150:complications* / Q000401:mortality / Q000628:therapy; D000925:Anticoagulants / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006341:Heart Rupture / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006342:Heart Rupture, Post-Infarction / Q000209:etiology / Q000401:mortality / Q000628:therapy; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000628:therapy; D055815:Young Adult
D000319:Adrenergic beta-Antagonists; D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight