Branch Segment Occlusion With Acute Myocardial Infarction is a Risk for Left Ventricular Free Wall Rupture

Ino, Yasushi; Kubo, Takashi; Tomobuchi, Yoshiaki; Oshika, Hiroyuki; Kitabata, Hironori; Obana, Masahiro; Tanimoto, Takashi; Takarada, Shigeho; Tanaka, Atsushi; Imanishi, Toshio; Okamura, Yoshitaka

doi:10.1253/circj.cj-08-1112

Cited by 16 publications

(11 citation statements)

References 34 publications

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“…In contrast, the frequency of cardiac rupture-related death did not vary between the groups. Hypertension, an advanced age, female gender, lower body mass index, delayed reperfusion, first AMI, one-vessel disease with a preserved left ventricular function, totally occluded LAD as the culprit vessel and small myocardial infarction due to branch occlusion have been reported to be risk factors for cardiac rupture (13)(14)(15). Although, in the present study, data regarding non-fatal cardiac rupture and the left ventricular function were lacking, the risk of ventricular rupture in the Killip 1 patients, who exhibited a lack of signs of heart failure and/ or shock, smaller peak CK values and a higher prevalence of one-vessel disease, was almost equal to that observed in the Killip 2-4 patients, who demonstrated a higher age and higher proportion of women.…”

Section: Discussionmentioning

confidence: 99%

Predictors of In-hospital Outcomes after Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction in Patients with a High Killip Class

et al. 2014

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Objective The predictors of in-hospital outcomes after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) complicated with heart failure or cardiogenic shock at presentation remain unclear. Methods Using the AMI-Kyoto Multi-Center Risk Study database, the clinical background characteristics, angiographic findings, primary PCI results, and in-hospital prognoses were retrospectively compared between primary PCI-treated AMI patients with a Killip class status of ! 2 (Killip 2-4 patients, n=390) and those with a Killip class 1 status (Killip 1 patients, n=1,057). Results The Killip 2-4 patients were more likely to have a higher age and proportion of women and exhibited a higher prevalence of previous myocardial infarction, diabetes mellitus and chronic kidney disease or anemia on admission, lower systolic blood pressure (SBP) values on admission, a higher rate of multivessels or left main trunk as the culprit artery, a larger number of diseased vessels, a lower Thrombolysis In Myocardial Infarction (TIMI) grade in the infarct-related artery (IRA) before/after primary PCI and a significantly higher in-hospital mortality rate than the Killip 1 patients. According to a multivariate analysis, age was found to be an independent positive predictor of in-hospital mortality, while admission SBP was an independent positive predictor of in-hospital survival in both groups. In contrast, anemia on admission was found to be an independent predictor of in-hospital death, while the TIMI 3 flow in the IRA after PCI was found to be an independent factor for survival in the Killip 2-4 patients, but not the Killip 1 patients. Conclusion Anemia on admission and the final TIMI 3 flow in the IRA are critical determinants of inhospital death in AMI patients with a Killip class status of ! 2 undergoing primary PCI.

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Section: Discussionmentioning

confidence: 99%

Predictors of In-hospital Outcomes after Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction in Patients with a High Killip Class

et al. 2014

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“…More recently, preserved LV function -hence an increased wall stress in the infarct zone -has been identified as an independent risk factor for LVFWR. MI with the culprit lesion lying in a branch of one of the main vessels has also been stated as a risk factor (6). Unlike traditional risk factors, the latter were present in this case.…”

Section: Discussionmentioning

confidence: 58%

Conservative Treatment of Left Ventricular Free Wall Rupture

Dewulf

Cathenis

Goossens

2015

Acta Chirurgica Belgica

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We present a case of post-infarction Left Ventricular Free Wall Rupture (LVFWR), in which conservative treatment was successfully applied. A 48-year old male patient presented at our emergency department with abdominal pain and a clinical presentation of shock. There had been an episode of chest pain three days before admission. Electrocardiogram was suggestive for old myocardial infarction. Coronarography revealed an occlusion of a diagonal branch. Computed Tomography scan was performed to exclude a rupturing aortic aneurysm, but a large pericardial effusion was seen. Echocardiography confirmed the diagnosis of cardiac tamponade and pericardiocentesis was performed. Conservative treatment consisting of bed rest, blood pressure control and beta-blocker therapy was applied, allowing the patient to be discharged after 10 days. The diagnosis of LVFWR was confirmed by cardiac magnetic resonance imaging.Surgery is considered as the golden standard in treatment of LVFWR. This case illustrates that in selected patients conservative treatment is possible.

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“…The incidence ranges from 0.93% to 2.7% according to different registries (2,10). In one recent Japan study of angiography-documented MI, the incidence is 2.96% among 439 subjects (11). In the postmortem examination, cardiac rupture is present in 30.7% of MI-related mortality (12).…”

Section: Discussionmentioning

confidence: 99%

“…Early reperfusion ensures greater patency of the infarct-related artery (IRA) and results in reduction of infarct size and rates of ventricular rupture (8,18). A recent study also suggested the decreased possibility of revascularization of branch-segment occlusion leads to a higher incidence of free wall rupture (10% vs. 1.6%, p<0.001) (11). Whether late thrombolysis carries an increase in risk of cardiac rupture is controversial (10,19).…”

Section: Discussionmentioning

confidence: 99%

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Acute Left Ventricular Rupture Following Posterior Wall Myocardial Infarction

et al. 2010

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Free wall rupture, the most fearful complication of myocardial infarction, mostly attacks anterior walls. Acute rupture is characterized by rapid development of mechanical arrest accompanied with bradyarrhythmia or electromechanical dissociation. The majority of patients succumb to death as the result of cardiac tamponade. Risk factors are advanced age, female gender, the first-time myocardial infarction, hypertension, and STsegment elevation. We report a rare case of posterior wall myocardial infarction complicated with left ventricular rupture initially presenting with junctional escape rhythm.

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Branch Segment Occlusion With Acute Myocardial Infarction is a Risk for Left Ventricular Free Wall Rupture

Cited by 16 publications

References 34 publications

Predictors of In-hospital Outcomes after Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction in Patients with a High Killip Class

Predictors of In-hospital Outcomes after Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction in Patients with a High Killip Class

Conservative Treatment of Left Ventricular Free Wall Rupture

Acute Left Ventricular Rupture Following Posterior Wall Myocardial Infarction

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