Journal of Nippon Medical School: Vol.69 No.5 page.481

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ArticleTitle Clinical Course, Timing of Rupture and Relationship with Coronary Recanalization Therapy in 77 Patients with Ventricular Free Wall Rupture Following Acute Myocardial Infarction

AuthorList Keiji Tanaka¹, Naoki Sato¹, Masahiro Yasutake¹, Shinhiro Takeda¹, Teruo Takano² and Shigeo Tanaka³

Affiliation ¹Division of Intensive and Coronary Care Unit, Nippon Medical School Hospital, ²First Department of Internal Medicine, Nippon Medical School, ³Department of Cardiovascular Surgery, Nippon Medical School

Language EN

Volume 69

Issue 5

Year 2002

Page 481-488

Received May 15, 2002

Accepted May 30, 2002

Keywords free wall rupture, acute myocardial infarction, coronary recanalization therapy, oozing type, abrupt type

Abstract This study aimed to analyze the clinical course, timing of rupture and relationship with percutaneous coronary intervention (PCI) in patients with cardiac free wall rupture (FWR) following acute myocardial infarction (AMI). FWR was observed in 77 (2.3%) of 3, 284 patients with AMI in our CCU over 28 years. 47 (61.0%) cases were male and mean of age was 69.8 year old. Rupture occurred on Day 1 of infarction in 46 patients (59.7%). 22 cases (28.6%) had cardiogenic shock before FWR. 10 cases (13.0%) had double rupture preceded by ventricular septal perforation (VSP). 25 cases (32.5%) were treated with thrombolytic agents, and only 10 cases (13.0%) had percutaneous coronary intervention (PCI). Before 1981, when PCI was not indicated, incidence of FWR was 2.7%. After 1988 (the era of PCI), the incidence decreased to 1.1%. FWR and the era showed a significant negative correlation (r=0.519: P=0.0056).
Rupture was abrupt in 51 cases (66.2%: abrupt type) and was gradual in 26 cases (33.8%: oozing type). The percentages of female, patients with cardiogenic shock before rupture, patients treated by thrombolytic agents and survival rate were significantly higher in the slow-onset rupture group than in the abrupt-onset rupture group. The percentage of patients treated by PCI was extremely low (7.8%) in abrupt-onset group.
Of all patients, only 8 (10.4%) survived by emergency operation. One patient with abrupt type survived emergency pericardtomy in the CCU. One patient with abrupt type and 4 patients with oozing type who had emergency operation in operation room survived. 2 patients with oozing type survived by pericardial drainage and strict blood pressure control.
We conclude that early recognition and emergency surgery without thrombolytic therapy may substantially reduce mortality in oozing ruptures. Moreover, immediate and adequate reperfusion by PCI may prevent development of abrupt rupture following acute myocardial infarction.

Correspondence to Keiji Tanaka, MD, Director of Division of Intensive and Coronary Care Unit, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
k-tanaka@nms.ac.jp

ArticleTitle	Clinical Course, Timing of Rupture and Relationship with Coronary Recanalization Therapy in 77 Patients with Ventricular Free Wall Rupture Following Acute Myocardial Infarction
AuthorList	Keiji Tanaka¹, Naoki Sato¹, Masahiro Yasutake¹, Shinhiro Takeda¹, Teruo Takano² and Shigeo Tanaka³
Affiliation	¹Division of Intensive and Coronary Care Unit, Nippon Medical School Hospital, ²First Department of Internal Medicine, Nippon Medical School, ³Department of Cardiovascular Surgery, Nippon Medical School
Language	EN
Volume	69
Issue	5
Year	2002
Page	481-488
Received	May 15, 2002
Accepted	May 30, 2002
Keywords	free wall rupture, acute myocardial infarction, coronary recanalization therapy, oozing type, abrupt type
Abstract	This study aimed to analyze the clinical course, timing of rupture and relationship with percutaneous coronary intervention (PCI) in patients with cardiac free wall rupture (FWR) following acute myocardial infarction (AMI). FWR was observed in 77 (2.3%) of 3, 284 patients with AMI in our CCU over 28 years. 47 (61.0%) cases were male and mean of age was 69.8 year old. Rupture occurred on Day 1 of infarction in 46 patients (59.7%). 22 cases (28.6%) had cardiogenic shock before FWR. 10 cases (13.0%) had double rupture preceded by ventricular septal perforation (VSP). 25 cases (32.5%) were treated with thrombolytic agents, and only 10 cases (13.0%) had percutaneous coronary intervention (PCI). Before 1981, when PCI was not indicated, incidence of FWR was 2.7%. After 1988 (the era of PCI), the incidence decreased to 1.1%. FWR and the era showed a significant negative correlation (r=0.519: P=0.0056). Rupture was abrupt in 51 cases (66.2%: abrupt type) and was gradual in 26 cases (33.8%: oozing type). The percentages of female, patients with cardiogenic shock before rupture, patients treated by thrombolytic agents and survival rate were significantly higher in the slow-onset rupture group than in the abrupt-onset rupture group. The percentage of patients treated by PCI was extremely low (7.8%) in abrupt-onset group. Of all patients, only 8 (10.4%) survived by emergency operation. One patient with abrupt type survived emergency pericardtomy in the CCU. One patient with abrupt type and 4 patients with oozing type who had emergency operation in operation room survived. 2 patients with oozing type survived by pericardial drainage and strict blood pressure control. We conclude that early recognition and emergency surgery without thrombolytic therapy may substantially reduce mortality in oozing ruptures. Moreover, immediate and adequate reperfusion by PCI may prevent development of abrupt rupture following acute myocardial infarction.
Correspondence to	Keiji Tanaka, MD, Director of Division of Intensive and Coronary Care Unit, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan k-tanaka@nms.ac.jp