A composite view of cardiac rupture in the United States National Registry of Myocardial Infarction

Cardiovascular Thrombosis Research Center, Clinical Trials Section, University of Massachusetts Medical School, Worcester 01655, USA.

OBJECTIVES: This study was done to determine the incidence, timing and prevalence as a cause of death from cardiac rupture in patients with acute myocardial infarction. BACKGROUND: Several clinical trials and overview analyses have suggested that the survival benefit conferred by thrombolytic therapy may be offset by a paradoxic increase in early deaths from cardiac rupture. METHODS: Demographic, procedural and outcome data from patients with acute myocardial infarction were collected at 1,073 United States hospitals collaborating in the United States National Registry of Myocardial Infarction. RESULTS: Among the 350,755 patients enrolled, 122,243 received thrombolytic therapy. In-hospital mortality for the overall patient population, those not treated with thrombolytics (n = 228,512) and those given thrombolytics were 10.4%, 12.9% and 5.9%, respectively (p<0.001). Cardiogenic shock was the most common cause of death in each patient group. Although the incidence of cardiac rupture was low (<1.0%), it was responsible for 7.3%, 6.1% and 12.1%, respectively, of in-hospital deaths (p<0.001). Death from rupture occurred earlier in patients given thrombolytic therapy, with a clustering of events within 24 h of drug administration. Despite the early risk, death rates were comparatively low in thrombolytic-treated patients on each of the first 30 days. By multivariable analysis, thrombolytics, prior myocardial infarction, advancing age, female gender and intravenous beta-blocker use were independently associated with cardiac rupture. CONCLUSIONS: This large registry experience, including over 350,000 patients with myocardial infarction, suggests that thrombolytic therapy accelerates cardiac rupture, typically to within 24 to 48 h of treatment. The possibility that rupture represents an early hemorrhagic complication of thrombolytic therapy should be investigated.

This article has been cited by other articles:

				M. S. Lee, C.-H. Tseng, C. M. Barker, V. Menon, D. Steckman, R. Shemin, and J. S. Hochman Outcome after surgery and percutaneous intervention for cardiogenic shock and left main disease. Ann. Thorac. Surg., July 1, 2008; 86(1): 29 - 34. [Abstract] [Full Text] [PDF]

				G. Sakaguchi, T. Komiya, N. Tamura, and T. Kobayashi Surgical Treatment for Postinfarction Left Ventricular Free Wall Rupture Ann. Thorac. Surg., April 1, 2008; 85(4): 1344 - 1346. [Abstract] [Full Text] [PDF]

				M. Dencker, G. Tasevska, D. Grubb, M. Stagmo, and R. Gustafsson Unexpected rupture of the left ventricular free wall in the echo-lab Eur J Echocardiogr, January 1, 2008; 9(1): 92 - 94. [Abstract] [Full Text] [PDF]

				G. Weissman, C. C. Kwon, R. K. Shaw, and J. F. Setaro Free-Wall Rupture of the Myocardium Following Infarction: A Changing Clinical Portrait in the Reperfusion Era: A Case Report Angiology, October 1, 2006; 57(5): 636 - 642. [Abstract] [PDF]

				F. Sheikh, Y. Chen, X. Liang, A. Hirschy, A. E. Stenbit, Y. Gu, N. D. Dalton, T. Yajima, Y. Lu, K. U. Knowlton, et al. {alpha}-E-Catenin Inactivation Disrupts the Cardiomyocyte Adherens Junction, Resulting in Cardiomyopathy and Susceptibility to Wall Rupture Circulation, September 5, 2006; 114(10): 1046 - 1055. [Abstract] [Full Text] [PDF]

				J. S. Hochman, L. A. Sleeper, J. G. Webb, V. Dzavik, C. E. Buller, P. Aylward, J. Col, H. D. White, and for the SHOCK Investigators Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. JAMA, June 7, 2006; 295(21): 2511 - 2515. [Abstract] [Full Text] [PDF]

				M. A. Cavasin, Z.-Y. Tao, A.-L. Yu, and X.-P. Yang Testosterone enhances early cardiac remodeling after myocardial infarction, causing rupture and degrading cardiac function Am J Physiol Heart Circ Physiol, May 1, 2006; 290(5): H2043 - H2050. [Abstract] [Full Text] [PDF]

				H. Bueno, M. Martinez-Selles, E. Perez-David, and R. Lopez-Palop Effect of thrombolytic therapy on the risk of cardiac rupture and mortality in older patients with first acute myocardial infarction Eur. Heart J., September 1, 2005; 26(17): 1705 - 1711. [Abstract] [Full Text] [PDF]

				A. Babaev, P. D. Frederick, D. J. Pasta, N. Every, T. Sichrovsky, J. S. Hochman, and for the NRMI Investigators Trends in Management and Outcomes of Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock JAMA, July 27, 2005; 294(4): 448 - 454. [Abstract] [Full Text] [PDF]

				X.-M. Gao, Q. Xu, H. Kiriazis, A. M. Dart, and X.-J. Du Mouse model of post-infarct ventricular rupture: time course, strain- and gender-dependency, tensile strength, and histopathology Cardiovasc Res, February 1, 2005; 65(2): 469 - 477. [Abstract] [Full Text] [PDF]

				Y. Hirasawa, T. Miyauchi, T. Sawamura, and H. Takiya Giant Left Ventricular Pseudoaneurysm After Mitral Valve Replacement and Myocardial Infarction Ann. Thorac. Surg., November 1, 2004; 78(5): 1823 - 1825. [Abstract] [Full Text] [PDF]

				S. Arsan, S. Akgun, M. Turkmen, N. Kurtoglu, and T. Yildirim Delayed rupture of a postinfarction left ventricular true aneurysm Ann. Thorac. Surg., May 1, 2004; 77(5): 1813 - 1815. [Abstract] [Full Text] [PDF]

				H.-K. Yip, C.-Y. Fang, K.-T. Tsai, H.-W. Chang, K.-H. Yeh, M. Fu, and C.-J. Wu The Potential Impact of Primary Percutaneous Coronary Intervention on Ventricular Septal Rupture Complicating Acute Myocardial Infarction Chest, May 1, 2004; 125(5): 1622 - 1628. [Abstract] [Full Text] [PDF]

				H.-K. Yip, C.-J. Wu, H.-W. Chang, C.-P. Wang, C.-I Cheng, S. Chua, and M.-C. Chen Cardiac Rupture Complicating Acute Myocardial Infarction in the Direct Percutaneous Coronary Intervention Reperfusion Era Chest, August 1, 2003; 124(2): 565 - 571. [Abstract] [Full Text] [PDF]

				K. Lachapelle, B. deVarennes, P. L. Ergina, and R. Cecere Sutureless patch technique for postinfarction left ventricular rupture Ann. Thorac. Surg., July 1, 2002; 74(1): 96 - 101. [Abstract] [Full Text] [PDF]

				G R Rhydwen, S Charman, and P M Schofield Influence of thrombolytic therapy on the patterns of ventricular septal rupture after acute myocardial infarction Postgrad. Med. J., July 1, 2002; 78(921): 408 - 412. [Abstract] [Full Text] [PDF]

				M. E. Khalil, E. N. Heller, F. Boctor, E. J. Brown Jr, and I. A. Alhaddad Ventricular Free Wall Rupture in Acute Myocardial Infarction Journal of Cardiovascular Pharmacology and Therapeutics, September 1, 2001; 6(3): 231 - 236. [Abstract] [PDF]

				J. S. Hochman, L. A. Sleeper, H. D. White, V. Dzavik, S. C. Wong, V. Menon, J. G. Webb, R. Steingart, M. H. Picard, M. A. Menegus, et al. One-Year Survival Following Early Revascularization for Cardiogenic Shock JAMA, January 10, 2001; 285(2): 190 - 192. [Abstract] [Full Text] [PDF]

				J. Iemura, H. Oku, M. Otaki, H. Kitayama, T. Inoue, and T. Kaneda Surgical strategy for left ventricular free wall rupture after acute myocardial infarction Ann. Thorac. Surg., January 1, 2001; 71(1): 201 - 204. [Abstract] [Full Text] [PDF]

				J. S. Hochman, C. E. Buller, L. A. Sleeper, J. Boland, V. Dzavik, T. A. Sanborn, E. Godfrey, H. D. White, J. Lim, T. LeJemtel, et al. Cardiogenic shock complicating acute myocardial infarction--etiologies, management and outcome: a report from the SHOCK Trial Registry J. Am. Coll. Cardiol., September 1, 2000; 36(3_Suppl_A): 1063 - 1070. [Abstract] [Full Text] [PDF]

				V. Menon, H. White, T. LeJemtel, J. G. Webb, L. A. Sleeper, J. S. Hochman, and for the SHOCK Investigators The clinical profile of patients with suspected cardiogenic shock due to predominant left ventricular failure: a report from the SHOCK Trial Registry J. Am. Coll. Cardiol., September 1, 2000; 36(3_Suppl_A): 1071 - 1076. [Abstract] [Full Text] [PDF]

				S. C. Wong, T. Sanborn, L. A. Sleeper, J. G. Webb, R. Pilchik, D. Hart, S. Mejnartowicz, T. A. Antonelli, R. Lange, J. K. French, et al. Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry J. Am. Coll. Cardiol., September 1, 2000; 36(3_Suppl_A): 1077 - 1083. [Abstract] [Full Text] [PDF]

				D. M. Shindler, S. T. Palmeri, T. A. Antonelli, L. A. Sleeper, J. Boland, T. P. Cocke, J. S. Hochman, and for the SHOCK Investigators Diabetes mellitus in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry J. Am. Coll. Cardiol., September 1, 2000; 36(3_Suppl_A): 1097 - 1103. [Abstract] [Full Text] [PDF]

				J. Slater, R. J. Brown, T. A. Antonelli, V. Menon, J. Boland, J. Col, V. Dzavik, M. Greenberg, M. Menegus, C. Connery, et al. Cardiogenic shock due to cardiac free-wall rupture or tamponade after acute myocardial infarction: a report from the SHOCK Trial Registry J. Am. Coll. Cardiol., September 1, 2000; 36(3_Suppl_A): 1117 - 1122. [Abstract] [Full Text] [PDF]

				R. Pretre, A. Linka, R. Jenni, and M. I. Turina Surgical treatment of acquired left ventricular pseudoaneurysms Ann. Thorac. Surg., August 1, 2000; 70(2): 553 - 557. [Abstract] [Full Text] [PDF]

				R JUNEJA, R SHARMA, and S S KOTHARI Submitral pseudoaneurysm in purulent pericarditis Heart, June 1, 2000; 83(6): 713 - 713. [Full Text]

				R. Pretre, P. Benedikt, and M. I. Turina Experience with postinfarction left ventricular free wall rupture Ann. Thorac. Surg., May 1, 2000; 69(5): 1342 - 1345. [Abstract] [Full Text] [PDF]

				C. S. Hayward, R. P. Kelly, and P. Collins The roles of gender, the menopause and hormone replacement on cardiovascular function Cardiovasc Res, April 1, 2000; 46(1): 28 - 49. [Full Text] [PDF]

				B. S. Crenshaw, C. B. Granger, Y. Birnbaum, K. S. Pieper, D. C. Morris, N. S. Kleiman, A. Vahanian, R. M. Califf, and E. J. Topol Risk Factors, Angiographic Patterns, and Outcomes in Patients With Ventricular Septal Defect Complicating Acute Myocardial Infarction Circulation, January 4, 2000; 101(1): 27 - 32. [Abstract] [Full Text] [PDF]

				R. C. Becker and G. Aurigemma Reply J. Am. Coll. Cardiol., December 1, 1999; 34(7): 2151 - 2151. [Full Text] [PDF]

				J. S. Hochman, L. A. Sleeper, J. G. Webb, T. A. Sanborn, H. D. White, J. D. Talley, C. E. Buller, A. K. Jacobs, J. N. Slater, J. Col, et al. Early Revascularization in Acute Myocardial Infarction Complicated by Cardiogenic Shock N. Engl. J. Med., August 26, 1999; 341(9): 625 - 634. [Abstract] [Full Text] [PDF]

				K. A. Lee, J. G. Kirkpatrick, J. M. Moran, and A. T. Pezzella Left ventricular fibroma masquerading as postinfarction myocardial rupture Ann. Thorac. Surg., August 1, 1999; 68(2): 580 - 582. [Abstract] [Full Text] [PDF]

				N. R. Every, P. D. Frederick, M. Robinson, J. Sugarman, L. Bowlby, and H. V. Barron A comparison of the National Registry of Myocardial Infarction 2 with the Cooperative Cardiovascular Project J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1886 - 1894. [Abstract] [Full Text] [PDF]

				R. C. Becker, J. S. Hochman, C. P. Cannon, F. A. Spencer, S. P. Ball, M. J. Rizzo, E. M. Antman, and for the TIMI 9 Investigators Fatal cardiac rupture among patients treated with thrombolytic agents and adjunctive thrombin antagonists: Observations from the Thrombolysis and Thrombin Inhibition in Myocardial Infarction 9 Study J. Am. Coll. Cardiol., February 1, 1999; 33(2): 479 - 487. [Abstract] [Full Text] [PDF]

				B. R. Brodie, T. D. Stuckey, T. C. Wall, G. Kissling, C. J. Hansen, D. B. Muncy, R. A. Weintraub, and T. A. Kelly Importance of time to reperfusion for 30-day and late survival and recovery of left ventricular function after primary angioplasty for acute myocardial infarction J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1312 - 1319. [Abstract] [Full Text] [PDF]

				M I Walters and J L Caplin Atrioventricular fistula: an unusual complication of a ventricular pseudoaneurysm after myocardial infarction Heart, May 1, 1998; 79(5): 523 - 524. [Full Text]

				M. J. Reardon, C. L. Carr, A. Diamond, G. V. Letsou, H. J. Safi, R. Espada, and J. C. Baldwin Ischemic Left Ventricular Free Wall Rupture: Prediction, Diagnosis, and Treatment Ann. Thorac. Surg., November 1, 1997; 64(5): 1509 - 1513. [Abstract] [Full Text]

				S. V. Pislaru, L. Barrios, T. Stassen, L. Jun, C. Pislaru, and F. Van de Werf Infarct Size, Myocardial Hemorrhage, and Recovery of Function After Mechanical Versus Pharmacological Reperfusion : Effects of Lytic State and Occlusion Time Circulation, July 15, 1997; 96(2): 659 - 666. [Abstract] [Full Text]

				THROMBOLYTIC THERAPY: INCREASED, EARLIER RISK FOR CARDIAC RUPTURE Journal Watch (General), May 28, 1996; 1996(528): 5 - 5. [Full Text]