ORIGINAL ARTICLES   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2003 August;162(4):85-90

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: Italian

Heart rupture in acute myocardial infarction. Incidence and clinical characteristics

Genovesi Ebert A., Savoia M. T., Baldini U., Carluccio M., Casarosa F., Digiorgio A., Di Santo D., Pauletti M., Galli M.

Unità Operativa di Cardiologia ed Unità Coronarica, Spedali Riuniti, Azienda USL 6, Livorno

Aim. The aim of this study is to evaluate the incidence, clinical characteristics and evolution of heart rupture in acute myocardial infarction (AMI).
Methods. AMI patients admitted during the last 21 months have been reviewed. The diagnosis of heart rupture was made by echocardiography (ventricular septal defect, rupture of papillary muscle, new pericardial effusion >5 mm).
Results. Six hundred and one AMI patients have been reviewed (age 70±12 years, 69% male, 14% recurrences, 38% treated with fibrinolysis, death rate 16.1%). Twenty-seven heart rupture have been identified i.e. 4.5%: 4 involved ventricular septum, 3 papillary muscle and 20 left ventricular free wall. Heart rupture mortality rate in coronary care unit was 74% (20 patients, 23% of death due to AMI); 7 patients underwent surgical repair and 4 are still alive after more than 3 years. The patients with heart rupture were older than survivors (78.1±7 vs 68.7±12 years, p 0.0001) but not than patients died for other causes (79.6±10 years, p=ns). The prevalence of females was higher than in the overall population (62.9% vs 31.4 p=0.013). Fifty-two percent of heart ruptures occurred within 24 hours from admission and 68% within 48 hours. Fibrinolysis was not associated with higher heart rupture rate in comparison neither to survivors (33.3% vs 41.2%p=ns) nor to patients with other causes of death (33.3 vs 18.6%, p=ns).
Conclusion. Heart rupture is a catastrophic complication which accounts for 1/4 of deaths and is the 2nd cause of death for AMI. It is more represented among females and it is not favoured by fibrinolytic treatment.