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Risk factors, subtype profiles, and outcomes of cardiac rupture after acute myocardial infarction: a case-control
Dan Zhang1, Chaojie Huang2, Xiaosu Wang1
1Department of Clinical Laboratory, Wuhan Asia General Hospital, Wuhan Asia General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China.
Insights
Cardiac rupture (CR) following acute myocardial infarction (AMI) is often fatal. Key risk factors include lack of emergency PCI, advanced Killip class, female sex, and low albumin. Surgical repair may improve survival in selected patients.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Cardiac rupture (CR) is a severe mechanical complication of acute myocardial infarction (AMI), associated with over 50% mortality.
- Early identification of patients at high risk for CR is crucial, particularly in settings with delayed medical presentation.
- Limited contemporary data exists on CR predictors and outcomes in specific populations.
Purpose of the Study:
- To identify factors independently associated with cardiac rupture (CR) following acute myocardial infarction (AMI).
- To compare clinical characteristics and outcomes of different CR subtypes (free wall rupture, ventricular septal rupture, papillary muscle rupture).
- To evaluate predictors of in-hospital mortality among patients with CR.
Main Methods:
- Retrospective case-control study involving 71 CR patients and 213 AMI controls.
- Multivariable logistic regression was used to identify independent predictors of CR.
- Analysis included subtype comparisons, early vs. late rupture assessment, and in-hospital mortality correlates.
Main Results:
- Independent predictors of CR included absence of emergency percutaneous coronary intervention (PCI), Killip class III-IV, female sex, and lower serum albumin.
- Free wall rupture (FWR) exhibited significantly higher mortality (97.4%) compared to ventricular septal rupture (VSR) (57.1%).
- Early rupture (≤3 days) correlated with higher inflammatory markers, while late rupture (>3 days) was linked to delayed presentation and lower albumin.
Conclusions:
- Absence of emergency PCI, advanced Killip class, female sex, and hypoalbuminemia are key independent predictors of CR post-AMI.
- FWR and VSR present distinct clinical and hemodynamic profiles.
- Surgical repair was associated with reduced in-hospital mortality, suggesting the benefit of prompt multidisciplinary evaluation for CR patients.
Background:
Cardiac rupture (CR) is a fatal mechanical complication of acute myocardial infarction (AMI) with mortality rates exceeding 50%. Early identification of high-risk patients remains clinically important, especially in regions with delayed presentation and limited contemporary data.
Methods:
This retrospective case-control study included 71 unique patients with CR [free wall rupture (FWR) 39, ventricular septal rupture (VSR) 28, papillary muscle rupture (PMR) 4] and 213 AMI controls without mechanical complications (1:3 ratio, stratified by AMI type) from a tertiary hospital in Wuhan, China (June 2020-December 2025). Factors independently associated with CR were identified using multivariable logistic regression with the events-per-variable principle (≥10). Model discrimination was assessed by the C-statistic and calibration by the Hosmer-Lemeshow test. Subtype comparisons (FWR vs. VSR), early (≤3 days) vs. late (>3 days) rupture analysis, and in-hospital mortality correlates were also evaluated.
Results:
Patients with CR were older (69.6 ± 8.5 vs. 59.5 ± 11.7 years, P < 0.001), more frequently female (40.8% vs. 12.2%, P < 0.001), and had longer onset-to-door times (median 48 vs. 5 h, P < 0.001). In multivariable analysis, absence of emergency percutaneous coronary intervention (PCI) [odds ratio (OR) = 8.23, 95% confidence interval (CI) 3.45-19.66], Killip class III-IV (OR = 6.82, 95% CI 2.68-17.35), female sex (OR = 3.41, 95% CI 1.41-8.26), and lower serum albumin (OR = 0.84 per g/L, 95% CI 0.77-0.91) were independently associated with CR. FWR showed markedly higher mortality than VSR (97.4% vs. 57.1%, P < 0.001). Early rupture (≤3 days, 39.4%) was associated with more intense inflammatory activation and higher admission troponin, whereas late rupture (>3 days, 60.6%) was associated with lower albumin and markedly delayed presentation, appearing to correspond to different temporal clinical patterns. Surgical repair was the only factor associated with lower in-hospital mortality in the multivariable model (OR = 0.06, 95% CI 0.01-0.36, P = 0.002).
Conclusions:
Absence of emergency PCI, Killip class III-IV, female sex, and hypoalbuminemia were independently associated with CR after AMI. FWR and VSR showed different clinical and hemodynamic patterns. Surgical repair was associated with lower in-hospital mortality among selected CR patients, supporting prompt multidisciplinary evaluation while recognizing the likelihood of survivor and indication bias.
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