Document Detail

A composite view of cardiac rupture in the United States National Registry of Myocardial Infarction.
MedLine Citation:
PMID:  8626938     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: This study was done to determine the incidence, timing and prevalence as a cause of death from cardiac rupture in patients with acute myocardial infarction. BACKGROUND: Several clinical trials and overview analyses have suggested that the survival benefit conferred by thrombolytic therapy may be offset by a paradoxic increase in early deaths from cardiac rupture. METHODS: Demographic, procedural and outcome data from patients with acute myocardial infarction were collected at 1,073 United States hospitals collaborating in the United States National Registry of Myocardial Infarction. RESULTS: Among the 350,755 patients enrolled, 122,243 received thrombolytic therapy. In-hospital mortality for the overall patient population, those not treated with thrombolytics (n = 228,512) and those given thrombolytics were 10.4%, 12.9% and 5.9%, respectively (p<0.001). Cardiogenic shock was the most common cause of death in each patient group. Although the incidence of cardiac rupture was low (<1.0%), it was responsible for 7.3%, 6.1% and 12.1%, respectively, of in-hospital deaths (p<0.001). Death from rupture occurred earlier in patients given thrombolytic therapy, with a clustering of events within 24 h of drug administration. Despite the early risk, death rates were comparatively low in thrombolytic-treated patients on each of the first 30 days. By multivariable analysis, thrombolytics, prior myocardial infarction, advancing age, female gender and intravenous beta-blocker use were independently associated with cardiac rupture. CONCLUSIONS: This large registry experience, including over 350,000 patients with myocardial infarction, suggests that thrombolytic therapy accelerates cardiac rupture, typically to within 24 to 48 h of treatment. The possibility that rupture represents an early hemorrhagic complication of thrombolytic therapy should be investigated.
R C Becker; J M Gore; C Lambrew; W D Weaver; R M Rubison; W J French; A J Tiefenbrunn; L J Bowlby; W J Rogers
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  27     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1996 May 
Date Detail:
Created Date:  1996-06-26     Completed Date:  1996-06-26     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1321-6     Citation Subset:  AIM; IM    
Cardiovascular Thrombosis Research Center, Clinical Trials Section, University of Massachusetts Medical School, Worcester 01655, USA.
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MeSH Terms
Age Factors
Heart Rupture, Post-Infarction / mortality*
Multivariate Analysis
Myocardial Infarction / drug therapy*,  mortality
Sex Factors
Shock, Cardiogenic / mortality
Thrombolytic Therapy / adverse effects*
United States / epidemiology
Comment In:
J Am Coll Cardiol. 1997 Jan;29(1):221-2   [PMID:  8996319 ]

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