Cardiac Rupture – What Changed During the Last Years?

Purpose: Myocadial rupture is a fatal complication of acute myocardial infarction. During the last years management strategies of acute myocardial infarction have changed. Primary percutaneous coronary procedures replaced fibrinolytic therapy completely, thus reducing one of the major risk factors for myocardial rupture in ST elevation myocardial infarction. In this work we describe a group of patients who suffered myocardial rupture during the last years, and nobody was treated with thrombolytic therapy.

Methods: Digital database of our hospital was searched for all patients that experienced myocardial rupture during 2008-2015. Clinical, demographic, angiographic and echocardiographic data of these patients were retrieved and analyzed.

Results: Among 2380 patients admitted with acute myocardial infarction, 12 (0.5%) developed myocardial rupture. Mean age was 78, there were 7 men and 5 women. 10 patients had pericardial effusion already on admission. 7 patients underwent coronary angiography and in 4 primary percutaneous intervention was performed. 6 patients reached the operating room, all of them survived. All the patients that were treated conservatively died due to rupture. Factors related to the treatment strategy were advanced age ≥90 and cognitive impairment.

Conclusions: Risk of myocardial rupture may be diminished significantly by primary coronary intervention during acute myocardial infarction, but mortality is high. Early comprehensive echocardiographic exam and rapid surgery may contribute to improved survival.