[Does reperfusion modify the risk of heart rupture? Effects of early reperfusion]

The goal of this study was to evaluate whether early fibrinolytic therapy could reduce in-hospital mortality caused by cardiac rupture in patients with acute myocardial infarction (AMI). Based on the strong correlation between occurrence of left ventricular free wall rupture and development of sudden electromechanical dissociation (EMD) in patients with a first TAMI without relevant heart failure, we compare the incidence of this mechanism of death in patients treated with streptokinase and in those from a control group. The study included 406 patients with a first transmural AMI younger than 71 years who received intravenous streptokinase (SK) with 104 similar patients not treated with fibrinolytic agents. Mortality rate in patients treated with SK was 6% compared to 11% in those from the control group. Patients treated with SK presented a lower incidence of EMD than those from the control group (17% vs 72%; p < 0.002). A necropsy study carried out in 33% of cases, confirmed the existence of left ventricular free wall rupture in each of the 7 cases who presented EMD but in none of the 6 who died in shock. We conclude that left ventricular free wall rupture is the principal cause of mortality in patients admitted to a Coronary Care Unit with a first transmural AMI, and that fibrinolytic treatment reduces mortality mainly by reducing development of cardiac rupture.