Cardiac rupture risk estimation in patients with acute myocardial infarction treated with percutaneous coronary
Insights
Cardiac rupture (CR) is a deadly complication of acute myocardial infarction (AMI). Older age, female gender, and delayed treatment are key independent risk factors for CR in patients undergoing percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Cardiovascular Research
Background:
- Cardiac rupture (CR) is a significant cause of mortality following acute myocardial infarction (AMI).
- Despite advances in AMI treatment, CR remains a considerable challenge with high fatality rates.
- Identifying prognostic risk factors for CR in patients treated with percutaneous coronary intervention (PCI) is crucial.
Purpose of the Study:
- To determine the independent prognostic risk factors for cardiac rupture (CR) in patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI).
Main Methods:
- A retrospective analysis of 4,200 patients with AMI treated by PCI.
- Examination of 270 patients who died from AMI, with CR confirmed by post-mortem examination.
Main Results:
- Cardiac rupture (CR) occurred in 18.1% of patients.
- Univariable analysis identified older age, female gender, prior cardiac events, absence of prior MI history, specific ECG findings (QS complex), and delayed treatment (time to thrombolysis and PCI) as associated with higher CR rates.
- Multivariable analysis confirmed age (OR: 1.1), female gender (OR: 0.2), and time from symptom onset to PCI (OR: 1.15) as independent predictors of CR.
Conclusions:
- Advanced age, female sex, and delayed time from symptom onset to acute myocardial infarction (AMI) treatment are independent predictors of cardiac rupture (CR) in patients undergoing percutaneous coronary intervention (PCI).
- These findings are independent of prior fibrinolysis treatment.
- Understanding these risk factors can aid in risk stratification and potentially improve outcomes for AMI patients treated with PCI.
Background:
Cardiac rupture (CR) is a common cause of death following acute myocardial infarction (AMI). Despite improvements in AMI treatment, the frequency of CR remains considerable and in most cases leads to death. The aim of the study was to define the independent prognostic CR risk factors of AMI in patients treated with percutaneous coronary intervention (PCI).
Methods:
A total of 4,200 AMI patients treated by PCI were studied retrospectively. Two hundred and seventy patients who had died of AMI were examined. In all cases CR was confirmed in post-mortem examination.
Results:
Cardiac rupture occurred in 49 patients (18.1%). In the CR group, 24.4% patients received thrombolysis and 22.6% in the non-CR group (p = NS). The following characteristics were associated with a higher rate of CR in univariable analysis: age (70.3 +/- 3.2 vs. 65.2 +/- +/- 9.9; p < 0.001), female (75.0% vs. 60.2%; p < 0.001), prior cardiac event and absence of myocardial infarction history (61.2% vs. 40.2%; p < 0.05 and 14.2% vs. 33.4%; p < 0.05), presence of QS complex in first ECG (75.5% vs. 52.0%, p < 0.05) and multiple coronary heart disease (75.5% vs. 61.5%, p < 0.05), and long time from onset of symptoms to thrombolysis and to PCI (8.1 +/- 2.8 vs. 4.7 +/- 2.3 hours, p < 0.001 and 9.0 +/- 5.5 vs. 4.5 +/- 3.2 hours, p < 0.001). In the multivariable analysis, independent predictors of CR were: age (OR: 1.1; 95% CI: 1.02-1.19; p = 0.01); female gender (OR: 0.2; 95% CI: 0.07-0.52; p = 0.001); time from onset of symptoms to PCI (OR: 1.15; 95% CI: 1.07-1.47; p = 0.003).
Conclusions:
Old age, female gender and long time from onset of symptoms to AMI treatment (independent of previous fibrinolysis) are independent factors of CR in PCI patients. (Cardiol J 2007; 14: 538-543).
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