title: Trends in the clinical and pathological characteristics of cardiac rupture in patients with acute myocardial infarction over 35 years.
abstract: BACKGROUND
  There is little known about whether the clinical and pathological characteristics and incidence of cardiac rupture (CR) in patients with acute myocardial infarction (AMI) have changed over the years.
  
  
  RESULTS
  The incidence and clinical characteristics of CR were investigated in patients with AMI, who were divided into 3 cohorts: 1977-1989, 1990-2000, and 2001-2011. Of a total of 5699 patients, 144 were diagnosed with CR and 45 survived. Over the years, the incidence of CR decreased (1977-1989, 3.3%; 1990-2000, 2.8%; 2001-2011, 1.7%; P=0.002) in association with the widespread adoption of reperfusion therapy. The mortality rate of CR decreased (1977-1989, 90%; 1990-2000, 56%; 2001-2011, 50%; P=0.002) in association with an increase in the rate of emergent surgery. In multivariable analysis, first myocardial infarction, anterior infarct, female sex, hypertension, and age >70 years were significant risk factors for CR, whereas impact of hypertension on CR was weaker from 2001 to 2011. Primary percutaneous coronary intervention (PPCI) was a significant protective factor against CR. In 64 autopsy cases with CR, myocardial hemorrhage occurred more frequently in those who underwent PPCI or fibrinolysis than those who did not receive reperfusion therapy (no reperfusion therapy, 18.0%; fibrinolysis, 71.4%; PPCI, 83.3%; P=0.001).
  
  
  CONCLUSIONS
  With the development of medical treatment, the incidence and mortality rate of CR have decreased. However, first myocardial infarction, anterior infarct, female sex, and old age remain important risk factors for CR. Adjunctive cardioprotection against reperfusion-induced myocardial hemorrhage is emerging in the current PPCI era.
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.) Department of Advanced Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan (S.H., S.Y.).
authors.forename: Satoshi
authors.initials: S
authors.lastname: Honda
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.).
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Asaumi
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.).
authors.forename: Takafumi
authors.initials: T
authors.lastname: Yamane
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.).
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nagai
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.).
authors.forename: Tadayoshi
authors.initials: T
authors.lastname: Miyagi
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.).
authors.forename: Teruo
authors.initials: T
authors.lastname: Noguchi
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.).
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Anzai
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.).
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Goto
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.).
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ishihara
authors.affiliation: Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (K.N.).
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Nishimura
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.) Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (H.O.).
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.).
authors.forename: Hatsue
authors.initials: H
authors.lastname: Ishibashi-Ueda
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.) Department of Advanced Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan (S.H., S.Y.).
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D056988:Anterior Wall Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016009:Chi-Square Distribution; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D015912:Thrombolytic Therapy; D013997:Time Factors
keywords: Heart rupture; mortality; myocardial infarction; reperfusion