Ventricular septal and free wall rupture complicating acute myocardial infarction: Experience in the Multicenter Investigation of Limitation of Infarct Size

• Published in: The American heart journal Vol. 117; no. 4; pp. 809 - 818
• Main Authors: Pohjola-Sintonen, Sinikka, Muller, James E., Stone, Peter H., Willich, Stefan N., Antman, Elliott M., Davis, Vicki G., Parker, Corette B., Braunwald, Eugene
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.04.1989; Elsevier
• Subjects: Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Creatine Kinase - blood; Electrocardiography; Heart; Heart Rupture - pathology; Heart Rupture, Post-Infarction - mortality; Heart Rupture, Post-Infarction - pathology; Heart Septum - pathology; Heart Ventricles - pathology; Humans; Isoenzymes; Medical sciences; Multicenter Studies as Topic; Myocardial Infarction - enzymology; Myocardial Infarction - pathology; Myocardial Infarction - physiopathology; Risk Factors; Time Factors; Human; Ventricular septal defect; Infarct; Acute; Mortality; Risk factor; Tissue rupture; Myocardium; Cardiovascular disease; Complication; Coronary heart disease; Left ventricle
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/0002-8703(89)90617-0

Left ventricular rupture was studied in 849 patients enrolled in the Multicenter Investigation of Limitation of Infarct Size. Although documented rupture occurred in only 14 cases (1.7%), it accounted for 14% of in-hospital mortality. Seven of the 14 ruptures occurred within 2 days and 10 within 4 days of the MB-creatine kinase-determined onset of infarction. Three easily determined baseline characteristics defined a set of patients with a markedly increased risk of myocardial rupture. Rupture was 9.2 times more likely to occur in patients with all of the following characteristics than in the remaining patients: (1) no history of previous angina or myocardial infarction, (2) ST segment elevation or signs of Q wave development on the initial ECG, and (3) peak MB-creatine kinase value (≥ 150 IU/L). The risk of myocardial rupture with these three characteristics was 5.5%. Although these predictors are likely to be of little therapeutic value for free wall rupture, since most patients with that complication die within minutes of its onset, they may aid in alerting physicians to the early diagnosis and timely surgical correction of ventricular septal rupture.