Effect of nitrates on the frequency of left ventricular free wall rupture complicating acute myocardial infarction: A case-controlled study

Changes in Hospital Mortality Rates in 425 Patients With Acute ST-Elevation Myocardial Infarction and Cardiac Rupture Over a 30-Year Period

“…These beneficial effects were observed despite the increasing age of our patients, given that advanced age is one of the main risk factors for CR. 1,6,7 Thus, our results would further emphasize the need for early implementation of medical measures that may potentially prevent CR such as early myocardial reperfusion and the use of ␤-blockers and ACE inhibitors 11,23 in patients with high risk of CR, namely those with a first STEMI, Ͼ60 years of age, without overt heart failure, and without ST segment resolution. They also call for the ready availability of the medical-surgical team at almost any time of the day and highlight the urgency to shorten the time to hospital admission in STEMI patients, for the admission delay in CR patients was Ͼ29 hours even in the last 6-year period.…”

“…28 Moreover, most series did not combine FWR and SR. 1,2,16,19,20,22,23 We believe that the progressive reduction in the frequency of CR was, in all likelihood, multifactorial. Indeed, the increasing awareness of the need to seek early medical attention on the development of anginal symptoms has resulted in earlier hospital admission and earlier pain and blood pressure control.…”

“…Thus, it might be speculated that effective reperfusion could have reduced the incidence of CR, and perhaps its death rate, by sparing the outer zone of jeopardized myocardium, thereby reducing the extent and transmurality of STEMI. 22,29,30 Most of our CR patients were treated with nitrates, an agent claimed to reduce the incidence of this event, 23 but we had no comparison group without nitrates to assess this protective effect. Moreover, since the late 1980s, ␤-blockers have been added to treatment, although, as in other series, 3,5,31 they were given to Ͻ50% of STEMI patients in the early stage, partly because of arterial hypotension, chronic lung disease, incipient heart failure, or conduction abnormalities.…”

Successful experience of surgical treatment of postinfarction rupture of left ventricular free wall (brief literature review, case report)

“…Разрыв свободной стенки левого желудочка сердца (РССЛЖ) является смертельным осложнением острого инфаркта миокарда (ОИМ) и случается в 4-6% случаев [4][5][6][7][8], несмотря на то что летальность при ОИМ значи-тельно снизилась на фоне чрескожных коронарных вме-шательств (ЧКВ) и тромболизиса.…”

“…-закрытие дефекта без иссечения зоны инфаркта; -ушивание разрыва с иссечением зоны инфарциро-ванного миокарда с применением синтетической заплаты и без нее; -ушивание с применением матрацного шва, укре-пленного тефлоновыми прокладками; -L. Nunez в 1983 г. описал методику пришивания синтетической заплаты к эпикарду и поверхностным сло-ям миокарда в зоне РССЛЖ, без использования искус-ственного кровообращения (ИК) [8,24]; -широкий спектр синтетических и биологических клеев позволяет закрыть дефект, используя аутоперикард или синтетическую заплату, без применения швов через рыхлый миокард и без использования искусственного кровообращения [1,3,6]; -некоторые авторы описывают комбинирование методики, предложенной L. Nunez, и применения синте-тических клеев. Отмечается, что таким образом достига-ется более эффективный гемостаз.…”