title: Clinical manifestation of early phase left ventricular rupture complicating acute myocardial infarction in the primary PCI era.
abstract: OBJECTIVE
  Before reperfusion therapy was introduced, the incidence of ventricular septal and left ventricular free wall rupture complicating acute myocardial infarction (AMI) was 1-3%. Primary percutaneous coronary intervention (PCI) was expected to reduce the incidence of such mechanical complications.
  
  
  METHODS
  We retrospectively analysed 1290 AMI patients referred to our institute from January 2005 to January 2011. Primary PCI was done in 1002 cases of the study patients (77.7%).
  
  
  RESULTS
  Ventricular septal rupture (VSR) occurred in 19 cases (1.5%) and left ventricular free wall rupture (LVFR) in 17 cases (1.3%). Mean observation periods from onset to VSR and LVFR were 2.6 days. We demonstrated that risk factors for LV rupture were advanced age, female sex, absence of history of angina or myocardial infarction, lack of previous PCI, and absence of previous hypertension. Coronary angiography revealed that the culprit lesions of the left anterior descending artery or single vessel disease were the risk factors for LV rupture. Furthermore, in the present observation, 9 patients (47.4%) with VSR and 8 patients (47.1%) with LVFR developed LV rupture within 24h after symptoms onset (early rupture). The early rupture demonstrated extremely poor outcome compared with late rupture (in-hospital mortality was 88.2% in early rupture and 63.1% in late rupture).
  
  
  CONCLUSIONS
  Even in the patients' cohort with higher prevalence of primary PCI, LV rupture cases were not decreased in contrast to our expectations. More attention should be paid to early LV rupture cases within 24 h from symptom onset in those cases.
authors.affiliation: Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan. Electronic address: nozoe15@gmail.com.
authors.forename: Masatusugu
authors.initials: M
authors.lastname: Nozoe
authors.affiliation: Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Sakamoto
authors.affiliation: Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Taguchi
authors.affiliation: Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan.
authors.forename: Shinzou
authors.initials: S
authors.lastname: Miyamoto
authors.affiliation: Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Fukunaga
authors.affiliation: Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakao
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris; D003920:Diabetes Mellitus; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D006352:Heart Ventricles; D006801:Humans; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015912:Thrombolytic Therapy; D013997:Time Factors
keywords: Acute myocardial infarction; Left ventricular rupture; Percutaneous coronary intervention