Cardiac rupture is a catastrophic and generally unexpected (although not always unpredictable) complication of acute
myocardial infarction, and still represents a challenge for the hospital cardiologist. In fact, diagnostic criteria are not available which allow us to detect in the individual patients an impending
rupture. On the other hand the early diagnosis of the
rupture, although possible if based on clinical and echocardiographic criteria, allows only a small number of the patients to survive, and cannot be considered as a satisfying
solution for this clinical problem. Starting from these discouraging considerations, the finding is underscored that
heart rupture only rarely occurs among patients treated with primary coronary angioplasty. Thus primary angioplasty (unlike systemic thrombolysis) seems to be able to prevent the postinfarction
cardiac rupture. As a consequence, primary angioplasty should be considered instead systemic thrombolysis for the reperfusion treatment of patients with acute
myocardial infarction and clinically at risk for
cardiac rupture (i.e., those aged > 60 years and with ST-segment elevation at hospital admission).