Clinical manifestation of early phase left ventricular rupture complicating acute myocardial infarction in the primary PCI era.
OBJECTIVE
Before reperfusion therapy was introduced, the incidence of ventricular septal and left ventricular free wall rupture complicating acute myocardial infarction (AMI) was 1-3%. Primary percutaneous coronary intervention (PCI) was expected to reduce the incidence of such mechanical complications.


METHODS
We retrospectively analysed 1290 AMI patients referred to our institute from January 2005 to January 2011. Primary PCI was done in 1002 cases of the study patients (77.7%).


RESULTS
Ventricular septal rupture (VSR) occurred in 19 cases (1.5%) and left ventricular free wall rupture (LVFR) in 17 cases (1.3%). Mean observation periods from onset to VSR and LVFR were 2.6 days. We demonstrated that risk factors for LV rupture were advanced age, female sex, absence of history of angina or myocardial infarction, lack of previous PCI, and absence of previous hypertension. Coronary angiography revealed that the culprit lesions of the left anterior descending artery or single vessel disease were the risk factors for LV rupture. Furthermore, in the present observation, 9 patients (47.4%) with VSR and 8 patients (47.1%) with LVFR developed LV rupture within 24h after symptoms onset (early rupture). The early rupture demonstrated extremely poor outcome compared with late rupture (in-hospital mortality was 88.2% in early rupture and 63.1% in late rupture).


CONCLUSION
Even in the patients' cohort with higher prevalence of primary PCI, LV rupture cases were not decreased in contrast to our expectations. More attention should be paid to early LV rupture cases within 24 h from symptom onset in those cases.
['Nozoe|Masatusugu|M|', 'Sakamoto|Tomohiro|T|', 'Taguchi|Eiji|E|', 'Miyamoto|Shinzou|S|', 'Fukunaga|Takashi|T|', 'Nakao|Koichi|K|']
D000367:Age Factors D000368:Aged D000369:Aged, 80 and over D000787:Angina Pectoris D003920:Diabetes Mellitus D005260:Female D006342:Heart Rupture, Post-Infarction D006352:Heart Ventricles D006801:Humans D006973:Hypertension D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D062645:Percutaneous Coronary Intervention D012189:Retrospective Studies D012307:Risk Factors D012737:Sex Factors D015912:Thrombolytic Therapy D013997:Time Factors
Left ventricular rupture Acute myocardial infarction Percutaneous coronary intervention