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Postinfarction rupture of the left ventricular free wall: clinicopathologic correlates in 100 consecutive autopsy
K P Batts1, D M Ackermann, W D Edwards
1Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905.
Insights
Postinfarction left ventricular free wall rupture is common, often occurring within 7 days. Key risk factors include advanced age, female gender, hypertension, and first-time myocardial infarction.
Area of Science:
- Cardiovascular Pathology
- Myocardial Infarction Complications
Background:
- Left ventricular free wall rupture is a severe complication of myocardial infarction.
- Understanding risk factors and timing is crucial for patient management and outcomes.
Purpose of the Study:
- To investigate the clinicopathologic characteristics and risk factors associated with postinfarction left ventricular free wall rupture.
- To determine the temporal occurrence and anatomical location of rupture events.
Main Methods:
- Retrospective analysis of 100 consecutive autopsied cases of left ventricular free wall rupture.
- Histopathological examination to determine infarct age and characteristics.
- Review of patient demographics, medical history, and coronary artery disease status.
Main Results:
- 51% of deaths occurred in-hospital; 49% out-of-hospital.
- Common risk factors identified: age >60, female gender, hypertension, absence of left ventricular hypertrophy, first myocardial infarction, and specific infarct locations (midventricular, lateral).
- 58% of ruptures occurred within 5 days, and 80% within 7 days post-infarction.
Conclusions:
- Postinfarction left ventricular free wall rupture is associated with specific demographic and clinical factors.
- Early recognition of these risk factors may aid in identifying high-risk patients.
- The timing and location of rupture provide insights into the pathophysiology of this critical complication.
Abstract:
Among 100 consecutive autopsied cases of postinfarction rupture of the left ventricular free wall, 51% of the deaths were in-hospital and 49% were out of hospital. There were 51 men (mean age, 72 years) and 49 women (mean age, 76 years); 81% had multivessel disease. All had severe obstruction of at least one major epicardial coronary artery (98 atherosclerotic, one thrombotic, and one embolic). Acute coronary thrombosis was present in 73 cases and occurred on an atherosclerotic plaque in 72, 49 (68%) of which had associated plaque rupture. In 83 cases, the ruptured infarction represented the subject's first myocardial infarction. Despite a history of hypertension in 55 cases, appreciable left ventricular hypertrophy was observed in only 19 cases. By histopathologic age of infarction, 13 ruptures occurred during the first day, 45 between days 2 and 5, and 22 on days 6 and 7; thus, 58% occurred within 5 days and 80% within 7 days. The mid-ventricle was the most frequent site of rupture (66%). Ruptures most frequently involved the lateral aspect of the left ventricular free wall (44%). In 66 cases, the rupture tract occurred along the interface between viable and necrotic myocardium. Our findings support the observations of others that the risk factors for postinfarction left ventricular free wall rupture include age greater than 60 years, female gender, preexisting hypertension, absence of left ventricular hypertrophy, first myocardial infarction, and midventricular or lateral wall transmural infarctions.