Cardiac rupture complicating acute myocardial infarction: the clinical features from an observational study and animal e
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RESEARCH ARTICLE
Open Access
Cardiac rupture complicating acute myocardial infarction: the clinical features from an observational study and animal experiment Qun Lu1* , Ping Liu1, Jian-Hua Huo1, Yan-Ni Wang1, Ai-Qun Ma1, Zu-Yi Yuan1, Xiao-Jun Du2,3* and Ling Bai1
Abstract Background: Cardiac rupture (CR) is a fatal complication of ST-elevation myocardial infarction (STEMI) with its incidence markedly declined in the recent decades. However, clinical features of CR patients now and the effect of reperfusion therapy to CR remain unclear. We investigated the clinical features of CR in STEMI patients and the effect of reperfusion therapy to CR in mice. Methods: Two studies were conducted. In clinical study, data of 1456 STEMI patients admitted to the First Hospital, Xi’an Jiaotong University during 2015.12. ~ 2018.12. were analyzed. In experimental study, 83 male C57BL/6 mice were operated to induce MI. Of them, 39 mice were permanent MI (group-1), and remaining mice received reperfusion after 1 h ischemia (21 mice, group-2) or 4 h ischemia (23 mice, group-3). All operated mice were monitored up to day-10. Animals were inspected three times daily for the incidence of death and autopsy was done for all mice found died to determine the cause of death. Results: CR was diagnosed in 40 patients: free-wall rupture in 17, ventricular septal rupture in 20, and combined locations in 3 cases. CR presented in 19 patients at admission and diagnosed in another 21 patients during 1 ~ 14 days post-STEMI, giving an in-hospital incidence of 1.4%. The mortality of CR patients was high during hospitalization accounting for 39% of total in-hospital death. By multivariate logistic regression analysis, older age, peak CK-MB and peak hs-CRP were independent predictors of CR post-STEMI. In mice with non-reperfused MI, 17 animals (43.6%) died of CR that occurred during 3–6 days post-MI. In MI mice received early or delayed reperfusion, all mice survived to the end of experiment except one mouse died of acute heart failure. Conclusion: CR remains as a major cause of in-hospital death in STEMI patients. CR patients are characterized of being elderly, having larger infarct and more server inflammation. Experimentally, reperfusion post-MI prevented CR. Keywords: Cardiac rupture, Acute myocardial infarction, Sudden cardiac death, Prognosis, Risk factor, Reperfusion
* Correspondence: [email protected]; [email protected] 1 Department of Cardiovascular Medicine, First Affiliated Hospital, School of Medicine of Xi’an Jiaotong University, No.277 Yanta West Road, Xi’an, Shaanxi 710061, P.R. China 2 Experimental Cardiology Lab, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to th
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