Document Detail


Clinical course, timing of rupture and relationship with coronary recanalization therapy in 77 patients with ventricular free wall rupture following acute myocardial infarction.
MedLine Citation:
PMID:  12382012     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 pericardiotomy 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.
Authors:
Keiji Tanaka; Naoki Sato; Masahiro Yasutake; Shinhiro Takeda; Teruo Takano; Shigeo Tanaka
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of Nippon Medical School = Nippon Ika Daigaku zasshi     Volume:  69     ISSN:  1345-4676     ISO Abbreviation:  J Nippon Med Sch     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-10-16     Completed Date:  2003-02-25     Revised Date:  2012-09-25    
Medline Journal Info:
Nlm Unique ID:  100935589     Medline TA:  J Nippon Med Sch     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  481-8     Citation Subset:  IM    
Affiliation:
Division of Intensive and Coronary Care Unit, Nippon Medical School Hospital, Japan. k-tanada@nms.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angioplasty, Balloon, Coronary*
Female
Heart Rupture, Post-Infarction / etiology*,  surgery
Humans
Male
Middle Aged
Myocardial Infarction / therapy
Risk Factors
Shock, Cardiogenic / etiology
Thrombolytic Therapy
Time Factors

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