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Acute Myocardial Infarction in Rats
Published on: February 16, 2011
Cardiac rupture complicating acute myocardial infarction: the clinical features from an observational study and
Qun Lu1, Ping Liu2, Jian-Hua Huo2
1Department of Cardiovascular Medicine, First Affiliated Hospital, School of Medicine of Xi'an Jiaotong University, No.277 Yanta West Road, Xi'an, Shaanxi, 710061, P.R. China. luqun00@163.com.
Insights
Cardiac rupture (CR) remains a significant threat in ST-elevation myocardial infarction (STEMI). Reperfusion therapy post-myocardial infarction effectively prevents CR in experimental models, offering a potential clinical strategy.
Area of Science:
- Cardiology
- Experimental Medicine
- Pathophysiology
Background:
- Cardiac rupture (CR) is a severe complication of ST-elevation myocardial infarction (STEMI).
- Recent decades have seen a decline in CR incidence, but current clinical features and the impact of reperfusion therapy remain unclear.
- This study investigates CR in STEMI patients and evaluates reperfusion therapy's effect in a mouse model.
Purpose of the Study:
- To elucidate the current clinical characteristics of cardiac rupture in STEMI patients.
- To assess the efficacy of reperfusion therapy in preventing cardiac rupture following myocardial infarction.
- To identify predictors of cardiac rupture in STEMI.
Main Methods:
- A clinical retrospective analysis of 1456 STEMI patients admitted between December 2015 and December 2018.
- An experimental study involving 83 male C57BL/6 mice with induced myocardial infarction (MI), divided into permanent MI and reperfusion groups (1h and 4h ischemia).
- Monitoring of mice for mortality and autopsy to determine causes of death, alongside clinical data analysis using multivariate logistic regression.
Main Results:
- Cardiac rupture occurred in 1.4% of STEMI patients, with high in-hospital mortality (39%).
- Independent predictors for CR included older age, elevated peak CK-MB, and peak hs-CRP.
- In mice, 43.6% of those with permanent MI died from CR, whereas reperfusion therapy significantly improved survival, preventing CR.
Conclusions:
- Cardiac rupture remains a critical cause of in-hospital mortality in STEMI.
- Elderly patients with larger infarcts and severe inflammation are more susceptible to CR.
- Experimental evidence strongly suggests that reperfusion therapy post-MI is protective against cardiac rupture.
Background:
Cardiac rupture (CR) is a fatal complication of ST-elevation myocardial infarction (STEMI) with its incidence markedly declined in the recent decades. However, clinical features of CR patients now and the effect of reperfusion therapy to CR remain unclear. We investigated the clinical features of CR in STEMI patients and the effect of reperfusion therapy to CR in mice.
Methods:
Two studies were conducted. In clinical study, data of 1456 STEMI patients admitted to the First Hospital, Xi'an Jiaotong University during 2015.12. ~ 2018.12. were analyzed. In experimental study, 83 male C57BL/6 mice were operated to induce MI. Of them, 39 mice were permanent MI (group-1), and remaining mice received reperfusion after 1 h ischemia (21 mice, group-2) or 4 h ischemia (23 mice, group-3). All operated mice were monitored up to day-10. Animals were inspected three times daily for the incidence of death and autopsy was done for all mice found died to determine the cause of death.
Results:
CR was diagnosed in 40 patients: free-wall rupture in 17, ventricular septal rupture in 20, and combined locations in 3 cases. CR presented in 19 patients at admission and diagnosed in another 21 patients during 1 ~ 14 days post-STEMI, giving an in-hospital incidence of 1.4%. The mortality of CR patients was high during hospitalization accounting for 39% of total in-hospital death. By multivariate logistic regression analysis, older age, peak CK-MB and peak hs-CRP were independent predictors of CR post-STEMI. In mice with non-reperfused MI, 17 animals (43.6%) died of CR that occurred during 3-6 days post-MI. In MI mice received early or delayed reperfusion, all mice survived to the end of experiment except one mouse died of acute heart failure.
Conclusion:
CR remains as a major cause of in-hospital death in STEMI patients. CR patients are characterized of being elderly, having larger infarct and more server inflammation. Experimentally, reperfusion post-MI prevented CR.
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