Factors related to heart rupture in acute coronary syndromes in the Global Registry of Acute Coronary Events
Center for Outcomes Research; Department of Medicine, Division of Cardiovascular Medicine
Medical Subject Headings
Acute Coronary Syndrome; Adrenergic beta-Antagonists; Adult; Aged; Angina, Unstable; Anticoagulants; Cohort Studies; Female; Fibrinolytic Agents; Heart Rupture; Heart Rupture, Post-Infarction; Heparin, Low-Molecular-Weight; Hospital Mortality; Humans; Incidence; Male; Middle Aged; Myocardial Infarction; Young Adult
Health Services Research
AIMS: To determine the incidence and factors associated with heart rupture (HR) in acute coronary syndrome (ACS) patients.
METHODS AND RESULTS: Among 60 198 patients, 273 (0.45%) had HR (free wall rupture, n = 118; ventricular septal rupture, n = 155). Incidence was 0.9% for ST-segment elevation myocardial infarction (STEMI), 0.17% for non-STEMI, and 0.25% for unstable angina. Hospital mortality was 58 vs. 4.5% in patients without HR (P < 0.001). The incidence was lower in STEMI patients with primary percutaneous coronary intervention (PCI) than in those without (0.7 vs. 1.1%; P = 0.01), but primary PCI was not independently related to HR in adjusted analysis (P = 0.20). Independent variables associated with HR included: ST-segment elevation (STE)/left bundle branch block; ST-segment deviation; female sex; previous stroke; positive initial cardiac biomarkers; older age; higher heart rate; systolic blood pressure/30 mmHg decrease. Conversely, previous MI and the use of low-molecular-weight heparin and beta-blockers during first 24 h were identified as protective factors for HR.
CONCLUSION: The incidence of HR is low in patients with ACS, although its incidence is probably underestimated. Heart rupture occurs more frequently in ACS with STE and is associated with high hospital mortality. A number of variables are independently related to HR.
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Citation: Eur Heart J. 2010 Jun;31(12):1449-56. Epub 2010 Mar 15. Link to article on publisher's site
Lopez-Sendon, Jose; Gurfinkel, Enrique P.; Lopez de Sa, Esteban; Agnelli, Giancarlo; Gore, Joel M.; Steg, Phillippe Gabriel; Eagle, Kim A.; Cantadore, Jose Ruiz; FitzGerald, Gordon; and Granger, Christopher B., "Factors related to heart rupture in acute coronary syndromes in the Global Registry of Acute Coronary Events" (2010). GRACE Publications. 10.