Journal of Zhejiang University SCIENCE B

, Volume 14, Issue 8, pp 736–742 | Cite as

Risk of cardiac rupture after acute myocardial infarction is related to a risk of hemorrhage

  • Geng Qian
  • Hong-bin Liu
  • Jin-wen Wang
  • Chen Wu
  • Yun-dai Chen
Article

Abstract

Although cardiac rupture (CR) is a fatal mechanical complication of acute myocardial infarction (AMI), to date no predictive model for CR has been described. CR has common pathological characteristics with major bleeding. We aimed to investigate the relationship between the risk factors of major bleeding and CR. A total of 10 202 consecutive AMI patients were recruited, and mechanical complications occurred in 72 patients. AMI patients without CR were chosen as control group. Clinical characteristics including bleeding-related factors were compared between the groups. The incidences of free wall rupture (FWR), ventricular septal rupture (VSR), and papillary muscle rupture (PMR) were 0.39%, 0.21%, and 0.09%, respectively, and the hospital mortalities were 92.5%, 45.5%, and 10.0%, respectively. Female proportion and average age were significantly higher in the groups of FWR and VSR than in the control group (P<0.01); higher white blood cell count and lower hemoglobin were found in all CR groups (P<0.01). Compared to the control group, patients with CR were more likely to receive an administration of thrombolysis [26.39% vs. 13.19%, P<0.05], and were less likely to be treated with primary percutaneous coronary intervention (PCI) [41.67% vs. 81.60%, P<0.05]. The major bleeding scores (integer scores) of FWR, VSR, and PMR were (17.70±7.24), (21.91±8.33), and (18.60±7.88), respectively, and were significantly higher than that of the control group (11.72±7.71) (P<0.05). A regression analysis identified age, increased heart rate, anemia, higher white blood cell count, and thrombolysis as independent risk factors of CR, most of which were major bleeding-related factors. The patients with CR have a significantly higher risk of hemorrhage compared to the group without CR. Risk of CR after AMI is related to the risk of hemorrhage.

Key words

Acute myocardial infarction (AMI) Risk factor Hemorrhage 

CLC number

R541.4 

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References

  1. Altunkeser, B.B., Özdemir, K., Özdemir, A., Gök, H., 2002. A subacute left ventricular free wall rupture after thrombolytic and glycoprotein IIb/IIIa inhibitor treatment: an overlooked finding of left ventriculography. Jpn. Heart J., 43(3):289–293. [doi:10.1536/jhj.43.289]PubMedCrossRefGoogle Scholar
  2. Bueno, H., Martinez-Selles, M., Perez-David, E., López-Palop, R., 2005. Effect of thrombolytic therapy on the risk of cardiac rupture and mortality in older patients with first acute myocardial infarction. Eur. Heart J., 26(17):1705–1711. [doi:10.1093/eurheartj/ehi284]PubMedCrossRefGoogle Scholar
  3. Dhand, A., Nakagawa, K., Nagpal, S., Gelfand, J.M., Kim, A.S., Smith, W.S., Tihan, T., 2010. Cardiac rupture after intravenous t-PA administration in acute ischemic stroke. Neurocrit. Care, 13(2):261–262. [doi:10.1007/s12028-010-9384-8]PubMedCrossRefGoogle Scholar
  4. Fang, L., Gao, X.M., Moore, X.L., Kiriazis, H., Su, Y., Ming, Z., Lim, Y.L., Dart, A.M., Du, X.J., 2007. Differences in inflammation, MMP activation and collagen damage account for gender difference in murine cardiac rupture following myocardial infarction. J. Mol. Cell Cardiol., 43(5):535–544. [doi:10.1016/j.yjmcc.2007.06.011]PubMedCrossRefGoogle Scholar
  5. Fang, L., Gao, X.M., Samuel, C.S., Su, Y., Lim, Y.L., Dart, A.M., Du, X.J., 2008. Higher levels of collagen and facilitated healing protect against ventricular rupture following myocardial infarction. Clin. Sci. (Lond.), 115(3):99–106. [doi:10.1042/CS20070365]CrossRefGoogle Scholar
  6. Figueras, J., Alcalde, O., Barrabes, J.A., Serra, V., Alguersuari, J., Cortadellas, J., Lidon, R.M., 2008. Changes in hospital mortality rates in 425 patients with acute ST-elevation myocardial infarction and cardiac rupture over a 30-year period. Circulation, 118(25):2783–2789. [doi:10.1161/CIRCULATIONAHA.108.776690]PubMedCrossRefGoogle Scholar
  7. Figueras, J., Barrabes, J.A., Serra, V., Cortadellas, J., Lidon, R.M., Carrizo, A., Garcia-Dorado, D., 2010. Hospital outcome of moderate to severe pericardial effusion complicating ST-elevation acute myocardial infarction. Circulation, 122(19):1902–1909. [doi:10.1161/CIRCULA TIONAHA.109.934968]PubMedCrossRefGoogle Scholar
  8. French, J.K., Hellkamp, A.S., Armstrong, P.W., Cohen, E., Kleiman, N.S., O’Connor, C.M., Holmes, D.R., Hochman, J.S., Granger, C.B., Mahaffey, K.W., 2010. Mechanical complications after percutaneous coronary intervention in ST-elevation myocardial infarction (from APEX-AMI). Am. J. Cardiol., 105(1):59–63. [doi:10.1016/j.amjcard.2009.08.653]PubMedCrossRefGoogle Scholar
  9. Gao, R.L., Han, Y.L., Yang, X.C., Mao, J.M., Fang, W.Y., Wang, L., Shen, W.F., Li, Z.Q., Jia, G.L., Lv, S.Z., et al., 2010. Thorombolytic therapy with rescue percutaneous coronary intervention versus primary percutaneous coronary intervention in patients with acute myocardial infarction: a multicenter randomized clinical trial. Chin. Med. J. (Engl.), 123(11):1365–1372. [doi:10.3760/cma.j. issn.0366-6999.2010.11.002]Google Scholar
  10. Gao, X.M., Ming, Z., Su, Y., Fang, L., Kiriazis, H., Xu, Q., Dart, A.M., Du, X.J., 2010. Infarct size and post-infarct inflammation determine the risk of cardiac rupture in mice. Int. J. Cardiol., 143(1):20–28. [doi:10.1016/j.ijcard.2009.01.019]PubMedCrossRefGoogle Scholar
  11. Haddadin, S., Milano, A.D., Faggian, G., Morjan, M., Patelli, F., Golia, G., Franchi, P., Mazzucco, A., 2009. Surgical treatment of postinfarction left ventricular free wall rupture. J. Card. Surg., 24(6):624–631. [doi:10.1111/j.1540-8191.2009.00896.x]PubMedCrossRefGoogle Scholar
  12. Kameda, K., Matsunaga, T., Abe, N., Fujiwara, T., Hanada, H., Fukui, K., Fukuda, I., Osanai, T., Okumura, K., 2006. Increased pericardial fluid level of matrix metalloproteinase-9 activity in patients with acute myocardial infarction: possible role in the development of cardiac rupture. Circ. J., 70(6):673–678.PubMedCrossRefGoogle Scholar
  13. Kushner, F.G., Hand, M., Smith, S.C.Jr., King, S.B.3rd, Anderson, J.L., Antman, E.M., Bailey, S.R., Bates, E.R., Blankenship, J.C., Casey, D.E. Jr., et al., 2009. 2009 focused updates: ACC/AHA Guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 Guideline and 2007 focused update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (updating the 2005 Guideline and 2007 focused update): A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Circulation, 120(22):2271–2306. [doi:10.1161/CIRCULATIONAHA.109.192663]PubMedCrossRefGoogle Scholar
  14. López-Sendón, J., Gurfinkel, E.P., de Sa, E.L., Agnelli, G., Gore, J.M., Steg, P.G., Eagle, K.A., Cantador, J.R., Fitzgerald, G., Granger, C.B., et al., 2010. Factors related to heart rupture in acute coronary syndromes in the global registry of acute coronary events. Eur. Heart J., 31(12): 1449–1456. [doi:10.1093/eurheartj/ehq061]PubMedCrossRefGoogle Scholar
  15. Markowicz-Pawlus, E., Nozynski, J., Sedkowska, A., Jarski, P., Hawranek, M., Streb, W., Zielinska, T., Polonski, L., Kalarus, Z., 2007. Cardiac rupture risk estimation in patients with acute myocardial infarction treated with percutaneous coronary intervention. Cardiol. J., 14(6): 538–543.PubMedGoogle Scholar
  16. Mehran, R., Pocock, S.J., Nikolsky, E., Clayton, T., Dangas, G.D., Kirtane, A.J., Parise, H., Fahy, M., Manoukian, S.V., Feit, F., et al., 2010. A risk score to predict bleeding in patients with acute coronary syndromes. J. Am. Coll. Cardiol., 55(23):2556–2566. [doi:10.1016/j.jacc.2009.09.076]PubMedCrossRefGoogle Scholar
  17. Okino, S., Nishiyama, K., Ando, K., Nobuyoshi, M., 2005. Thrombolysis increases the risk of free wall rupture in patients with acute myocardial infarction undergoing percutaneous coronary intervention. J. Interv. Cardiol., 18(3):167–172. [doi:10.1111/j.1540-8183.2005.04110.x]PubMedCrossRefGoogle Scholar
  18. Pedrazzini, G., Santoro, E., Latini, R., Fromm, L., Franzosi, M.G., Mocetti, T., Staszewsky, L., Barlera, S., Tognoni, G., Maggioni, A.P., et al., 2008. Causes of death in patients with acute myocardial infarction treated with angiotensin-converting enzyme inhibitors: findings from the Gruppo Italiano per Lo Studio della Sopravvivenza nell’Infarto (GISSI)-3 trial. Am. Heart J., 155(2):388–394. [doi:10.1016/j.ahj.2007.10.015]PubMedCrossRefGoogle Scholar
  19. Qian, G., Wang, Z.F., Liu, H.B., Chen, Y.D., 2011. Clinical manifestations of 43 patients with acute myocardial infarction complicated by free wall rupture. Chin. J. Cardiol., 39(9):812–815 (in Chinese).Google Scholar
  20. Sakaguchi, G., Komiya, T., Tamura, N., Kobayashi, T., 2008. Surgical treatment for postinfarction left ventricular free wall rupture. Ann. Thorac. Surg., 85(4):1344–1346. [doi:10.1016/j.athoracsur.2007.12.073]PubMedCrossRefGoogle Scholar
  21. Sane, D.C., Mozingo, W.S., Becker, R.C., 2009. Cardiac rupture after myocardial infarction: new insights from murine models. Cardiol. Rev., 17(6):293–299. [doi:10. 1097/CRD.0b013e3181bf4ab4]PubMedCrossRefGoogle Scholar
  22. Subherwal, S., Bach, R.G., Chen, A.Y., Gage, B.F., Rao, S.V., Newby, L.K., Wang, T.Y., Gibler, W.B., Ohman, E.M., Roe, M.T., et al., 2009. Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction. The CRUSADE (can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of the ACC/AHA Guidelines) bleeding score. Circulation, 119(14):1873–1882. [doi:10.1161/CIRCULATIONAHA.108.828541]PubMedCrossRefGoogle Scholar
  23. van de Werf, F., Bax, J., Betriu, A., Blomstrom-Lundqvist, C., Crea, F., Falk, V., Filippatos, G., Fox, K., Huber, K., Kastrati, A., et al., 2008. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the task force on the management of ST-segment elevation acute myocardial infarction of the european society of cardiology. Eur. Heart J., 29(23):2909–2945. [doi:10.1093/eurheartj/ehn416]PubMedCrossRefGoogle Scholar
  24. Yip, H.K., Wu, C.J., Chang, H.W., Wang, C.P., Cheng, C.I., Chua, S., Chen, M.C., 2003. Cardiac rupture complicating acute myocardial infarction in the direct percutaneous coronary intervention reperfusion era. Chest, 124(2): 565–571.PubMedCrossRefGoogle Scholar

Copyright information

© Zhejiang University and Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Geng Qian
    • 1
  • Hong-bin Liu
    • 1
  • Jin-wen Wang
    • 1
  • Chen Wu
    • 1
  • Yun-dai Chen
    • 1
  1. 1.Department of CardiologyChinese People’s Liberation Army General HospitalBeijingChina

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