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

Abstract

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.

• Authors: R C Becker, J M Gore, C Lambrew, W D Weaver, R M Rubison, W J French, A J Tiefenbrunn, L J Bowlby, W J Rogers
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 27 Issue 6 Pg. 1321-6 (May 1996) ISSN: 0735-1097 [Print] United States
• PMID: 8626938 (Publication Type: Journal Article)

Topics

• Age Factors
• Aged
• Female
• Heart Rupture, Post-Infarction (mortality)
• Humans
• Male
• Multivariate Analysis
• Myocardial Infarction (drug therapy, mortality)
• Registries
• Sex Factors
• Shock, Cardiogenic (mortality)
• Thrombolytic Therapy (adverse effects)
• United States (epidemiology)