title: Cardiac Rupture: New Features of the Old Disease.
abstract: OBJECTIVE
  Myocardial rupture is a rare but a fatal complication of acute myocardial infarction. During recent years, treatment strategies of acute myocardial infarction have changed. Primary percutaneous coronary interventions have replaced fibrinolytic therapy, thus reducing one of the major risk factors for myocardial rupture. In this work, we describe a group of patients who suffered myocardial rupture, none of whom were treated with thrombolytic therapy.
  
  
  METHODS
  The digital database of our hospital was searched for all patients who experienced myocardial rupture between 2008 and 2015. The demographic, clinical, angiographic and echocardiographic data of these patients were analyzed.
  
  
  RESULTS
  Out of 2,380 patients admitted with acute myocardial infarction, 12 (0.5%) developed myocardial rupture. The mean age was 78 years, and there were 7 males and 5 females. Ten patients already had pericardial effusion on admission. Seven patients underwent coronary angiography, whilst primary percutaneous intervention was performed in 4 patients. Six patients entered the operating room and all survived the procedure. All patients who were treated conservatively died due to rupture. Factors related to the treatment strategy were advanced age (≥ 90 years) and cognitive impairment.
  
  
  CONCLUSIONS
  The risk of myocardial rupture may be diminished by primary coronary intervention during myocardial infarction, but mortality remains high. An early, comprehensive echocardiographic examination and rapid surgery may contribute to improved survival.
authors.affiliation: Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Marina
authors.initials: M
authors.lastname: Leitman
authors.forename: Ludmila
authors.initials: L
authors.lastname: Tsatskin
authors.forename: Alberto
authors.initials: A
authors.lastname: Hendler
authors.forename: Alex
authors.initials: A
authors.lastname: Blatt
authors.forename: Eli
authors.initials: E
authors.lastname: Peleg
authors.forename: Zvi
authors.initials: Z
authors.lastname: Vered
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications; D002561:Cerebrovascular Disorders / Q000150:complications; D017023:Coronary Angiography; D005260:Female; D006304:Health Status; D006341:Heart Rupture / Q000209:etiology* / Q000401:mortality*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D010490:Pericardial Effusion / Q000209:etiology; D012189:Retrospective Studies; D014336:Troponin / Q000097:blood
chemical_list: D014336:Troponin