Association between acute myocardial infarction-to-cardiac rupture time and in-hospital mortality risk: a retrospective analysis of multicenter registry data from the Cardiovascular Research Consortium-8 Universities (CIRC-8U)

Abstract

Despite the known association of cardiac rupture with acute myocardial infarction (AMI), it is still unclear whether the clinical characteristics are associated with the risk of in-hospital mortality in patients with AMI complicated by cardiac rupture. The purpose of this study was to investigate the association between the time of cardiac rupture occurrence and the risk of in-hospital mortality after AMI. We conducted a retrospective analysis of multicenter registry data from eight medical universities in Eastern Japan. From 10,278 consecutive patients with AMI, we included 183 patients who had cardiac rupture after AMI, and examined the incidence of in-hospital deaths during a median follow-up of 26 days. Patients were stratified into three groups according to the AMI-to-cardiac rupture time, namely the > 24-h group (n = 111), 24–48-h group (n = 20), and < 48-h group (n = 52). Cox proportional hazards regression analysis was used to estimate the hazard ratio (HR) and the confidence interval (CI) for in-hospital mortality. Around 87 (48%) patients experienced in-hospital death and 126 (67%) underwent a cardiac surgery. Multivariable Cox regression analysis revealed a non-linear association across the three groups for mortality (HR [CI]; < 24 h: 1.0, reference; 24–48 h: 0.73 [0.27–1.86]; > 48 h: 2.25 [1.22–4.15]) after adjustments for age, sex, Killip classification, percutaneous coronary intervention, blood pressure, creatinine, peak creatine kinase myocardial band fraction, left ventricular ejection fraction, and type of rupture. Cardiac surgery was independently associated with a reduction in the HR of mortality (HR [CI]: 0.27 [0.12–0.61]) and attenuated the association between the three AMI-to-cardiac rupture time categories and mortality (statistically non-significant) in the Cox model. These data suggest that the AMI-to-cardiac rupture time contributes significantly to the risk of in-hospital mortality; however, rapid diagnosis and prompt surgical interventions are crucial for improving outcomes in patients with cardiac rupture after AMI.

Risk factors for cardiac rupture after acute ST-segment elevation myocardial infarction during the percutaneous coronary intervention era: a retrospective case-control study

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MiR-223-3p affects myocardial inflammation and apoptosis following myocardial infarction via targeting FBXW7

“…When MI occurs, myocardial cells are irreversibly damaged and become necrotic due to hypoxia and decreased supply of adenosine triphosphate (ATP). After releasing their contents, necrotic cells activate the autoimmune system, resulting in a severe inflammatory response (12,13). Among the cytokines involved, the TNF, interleukin, and transforming growth factor families will further affect the survival of cardiomyocytes, change vascular endothelial function, and recruit inflammatory cells to the injured myocardium, so as to aggravate or improve the local injury of ischemic myocardium (14,15).…”

Diagnosis of post-myocardial infarction left ventricular rupture on CT

“…Temporising measures to restore haemodynamic stability en route to emergency theatre include inotropic support, intravenous fluids and pericardiocentesis. 2,4 Even with the availability of emergency surgery, mortality rates approach 90%. 1 …”

“… 1–3 Recent observational data suggest that cardiac rupture is more likely to occur within 24 to 48 h of an acute MI. 2,3 Even with prompt recognition, myocardial rupture can rapidly lead to electromechanical dissociation, cardiac tamponade, and sudden death. 1,2 We describe the clinical course and diagnosis of a patient with cardiac arrest secondary to myocardial rupture.…”