title: Comparison of the risk of left ventricular free wall rupture in Taiwanese patients with ST-elevation acute myocardial infarction undergoing different reperfusion strategies: A medical record review study.
abstract: Ventricular free wall rupture (VFWR) is the second most common cause of death in patients with acute ST-elevation myocardial infarction (STEMI). Nevertheless, few reports have investigated the factors, including different treatment strategies, associated with VFWR in Taiwanese patients. Therefore, the aim of this study was to compare the risk of VFWR in Taiwanese patients with acute STEMI who had received primary percutaneous coronary intervention (PCI), rescue PCI, scheduled PCI, thrombolytic therapy, and pharmacologic treatment. In this medical records review study, records of patients with acute STEMI admitted to a regional hospital in south Taiwan between March 1999 and October 2013 were screened. Multivariate stepwise logistic regression analysis was used to evaluate the association between the risk of VFWR and its independent factors. The overall incidence of VFWR among the 1545 patients with acute STEMI in this study was 1.6%. Compared with primary PCI, the risk of VFWR was significantly higher in patients who had received thrombolysis (adjusted odds ratio = 6.83, P = 0.003) or pharmacologic treatment alone (adjusted odds ratio = 3.68, P = 0.014). The risk of VFWR in patients receiving rescue PCI or scheduled PCI was not significantly different from that in patients receiving primary PCI. In addition, older age and Killip class >I were associated with an increased risk of VFWR in patients with acute STEMI, whereas the use of angiotensin-converting enzyme inhibitors was associated with a lower risk of VFWR. In conclusion, findings from this medical record review study provide support for the use of primary PCI, rescue PCI, and scheduled PCI over thrombolytic therapy and pharmacologic treatment in reducing the risk of VFWR in Taiwanese patients with acute STEMI.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital Department of Nursing, Chung Jen Junior College of Nursing, Health Sciences and Management, Chiayi Department of Beauty and Health Care, Min-Hwei Junior College of Health Care Management, Tainan City, Taiwan.
authors.forename: Rei-Yeuh
authors.initials: RY
authors.lastname: Chang
authors.forename: Han-Lin
authors.initials: HL
authors.lastname: Tsai
authors.forename: Ping-Gune
authors.initials: PG
authors.lastname: Hsiao
authors.forename: Chao-Wen
authors.initials: CW
authors.lastname: Tan
authors.forename: Chi-Pin
authors.initials: CP
authors.lastname: Lee
authors.forename: I-Tseng
authors.initials: IT
authors.lastname: Chu
authors.forename: Yung-Ping
authors.initials: YP
authors.lastname: Chen
authors.forename: Cheng-Yun
authors.initials: CY
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006341:Heart Rupture / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D018570:Risk Assessment; D000072657:ST Elevation Myocardial Infarction / Q000150:complications* / Q000628:therapy*; D013624:Taiwan; D015912:Thrombolytic Therapy