Document Detail


Fatal myocardial rupture after acute myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: the VALsartan In Acute myocardial iNfarcTion Trial (VALIANT).
MedLine Citation:
PMID:  20598985     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Myocardial rupture is a relatively rare and usually fatal complication of myocardial infarction (MI). Early recognition of patients at greatest risk of myocardial rupture provides an opportunity for early intervention. METHODS: VALIANT was a double-blind, randomized, controlled trial comparing valsartan, captopril, and their combination in high-risk patients post-MI. Myocardial rupture was identified by autopsy (available in 138/589 patients dying within 30 days of index MI), echocardiography, direct surgical visualization, or presence of hemopericardium. An independent clinical end points committee reviewed medical records for all deaths or suspected nonfatal cardiovascular events. RESULTS: Rupture was identified in 45 (0.31%) patients enrolled in VALIANT, occurring 9.8 +/- 6.0 days after the qualifying MI. Rupture accounted for 7.6% (45/589) of all deaths occurring in the first 30 days of follow-up and 24% (33/138) of deaths in which autopsies were obtained. Compared with survivors, rupture was associated with increased age, hypertension, increased Killip class, lower estimated glomerular filtration rate, and Q wave MI, and inversely related to beta-blocker and diuretic use. Compared with patients who died of other causes within 30 days, patients with myocardial rupture were more likely to have had an inferior MI, Q wave MI, or hypertension; to have used oral anticoagulants; or to have received thrombolytic therapy. CONCLUSIONS: Although rare, myocardial rupture accounted for nearly one fourth of all deaths within the first 30 days after high-risk MI, suggesting an estimated incidence of approximately 1% within the first 30 days. A number of clinical characteristics may identify post-MI patients at higher risk of myocardial rupture.
Authors:
Faisal Shamshad; Satish Kenchaiah; Peter V Finn; Jordi Soler-Soler; John J V McMurray; Eric J Velazquez; Aldo P Maggioni; Robert M Califf; Karl Swedberg; Lars Kober; Yuri Belenkov; Sergei Varshavsky; Marc A Pfeffer; Scott D Solomon;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  American heart journal     Volume:  160     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-05     Completed Date:  2010-08-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  145-51     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010 Mosby, Inc. All rights reserved.
Affiliation:
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angiotensin II Type 1 Receptor Blockers / therapeutic use*
Cause of Death / trends
Female
Follow-Up Studies
Heart Failure / etiology*,  physiopathology
Heart Rupture, Post-Infarction / diagnosis,  epidemiology*,  etiology
Humans
Male
Middle Aged
Myocardial Infarction / complications,  drug therapy*,  mortality
Prognosis
Retrospective Studies
Tetrazoles / therapeutic use*
Time Factors
Valine / analogs & derivatives*,  therapeutic use
Ventricular Dysfunction, Left / etiology*,  mortality,  physiopathology
Chemical
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Tetrazoles; 137862-53-4/valsartan; 7004-03-7/Valine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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