title: Long-term outcome and risk prediction in patients suffering acute myocardial infarction complicated by post-infarction cardiac rupture.
abstract: BACKGROUND
  Post-infarction cardiac rupture (CR) such as ventricular septal rupture (VSR), free wall rupture (FWR), atrial septal rupture (ASR) or papillary muscle rupture (PMR) is a rare but dreaded complication in patients with acute myocardial infarction (AMI) associated with a very poor prognosis with reported mortality rates between 60 and 100%. Therefore suitable risk stratification for secondary prevention seems crucial, but data on long-term survival und risk prediction in this especially vulnerable patient collective remains scarce.
  
  
  METHODS
  Out of 11,641 patients presenting with AMI a total of 28 individuals suffering post-infarction CR were identified and stratified in "acute survivors of CR" (n=10) and "non-survivors of CR" (n=18). Cox regression hazard analysis was used to assess prognosticators on long-term survival.
  
  
  RESULTS
  Ten patients (35.7%) survived the initial event. After a median follow-up time of 9years 2 (20%) of the survivors died, both due to cardiovascular causes. Younger age (p=0.023) and higher systolic blood pressure at admission (p=0.018) turned out to be significant predictors of long-term survival. Systolic blood pressure 48h after CR proved to be a strong and independent predictor for survival with an adjusted hazard ratio per one standard deviation of 0.89 (95% CI: 0.72-0.99; 0.048).
  
  
  CONCLUSIONS
  Hemodynamic stabilization and severity of cardiogenic shock were detected as clinically most common among patients suffering post-infarction CR and proved to be of major importance for survival. If survival of the initial event was achieved, satisfying long-term mortality could be reached.
authors.affiliation: Department of Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sulzgruber
authors.affiliation: Department of Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
authors.forename: Feras
authors.initials: F
authors.lastname: El-Hamid
authors.affiliation: Department of Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Koller
authors.affiliation: Department of Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Forster
authors.affiliation: Department of Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Goliasch
authors.affiliation: Department of Medicine II, Division of Cardiology, Medical University of Vienna, Austria; Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria; Core Facilities, Medical University of Vienna, Vienna, Austria.
authors.forename: Johann
authors.initials: J
authors.lastname: Wojta
authors.affiliation: Department of Medicine II, Division of Cardiology, Medical University of Vienna, Austria. Electronic address: alexander.niessner@meduniwien.ac.at.
authors.forename: Alexander
authors.initials: A
authors.lastname: Niessner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute myocardial infarction; Cardiac rupture; Mortality; Prognostication