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Cardiac Rupture Complicating Acute and Subacute Myocardial Infarction at Forensic Autopsy
Megan Dukes1, Alison Krywanczyk2
1Cleveland Clinic Foundation.
Insights
Cardiac rupture following myocardial infarction is a severe complication. This autopsy study found older, White patients with fewer signs of heart disease were at higher risk, with longer symptom duration.
Area of Science:
- Cardiovascular Pathology
- Forensic Medicine
Background:
- Cardiac rupture is a feared complication of myocardial infarction, despite decreased incidence.
- Early identification of high-risk individuals and modifiable risk factors is crucial for improving outcomes.
Purpose of the Study:
- To identify risk factors and characteristics of patients experiencing cardiac rupture post-myocardial infarction using autopsy data.
- To compare rupture cases with non-rupture cases to understand differences in patient demographics and pathology.
Main Methods:
- Retrospective review of 288 autopsies for myocardial infarction cases between 2010 and 2024.
- Comparison of demographic, clinical history, and autopsy findings between cardiac rupture and non-rupture groups.
Main Results:
- 22% of myocardial infarction cases (63/288) were complicated by cardiac rupture.
- Patients with cardiac rupture were more likely to be White, older, and less likely to show cardiomegaly, myocardial fibrosis, or have a history of diabetes mellitus.
- The study group exhibited a higher cardiac rupture rate and longer preceding symptom duration than previously reported.
Conclusions:
- Cardiac rupture in myocardial infarction may present differently than previously understood, with specific demographic and pathological profiles.
- Further research is needed to elucidate the mechanisms and refine early detection strategies for cardiac rupture.
Abstract:
With the advent of percutaneous coronary reperfusion, the incidence of cardiac rupture in the setting of myocardial infarction has decreased substantially. Yet cardiac rupture remains a widely feared complication due to its rapid onset and limited therapeutic options. The early identification of individuals most at risk for rupture, as well as modifiable risk factors that contribute to delays in therapy, is crucial for improving outcomes associated with this disease. A retrospective review of autopsies performed between 2010 and 2024 at the Cuyahoga Office of Chief Medical Examiner revealed 288 cases of myocardial infarction, of which 63 (22%) were complicated by cardiac rupture. Decedents with cardiac rupture were more likely to be White and older than decedents without rupture. When compared with age, race, and sex-matched controls, decedents with rupture were less likely to demonstrate cardiomegaly and myocardial fibrosis at autopsy and to have a documented history of diabetes mellitus. There was no difference in the receipt of cardiopulmonary resuscitation between the groups. The study group demonstrated a much higher rate of cardiac rupture and a longer duration of preceding symptoms than has been previously reported in clinical studies.
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