| A composite view of cardiac rupture in the United States National Registry of Myocardial Infarction. | |
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MedLine Citation:
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PMID: 8626938 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article |
Journal Detail:
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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:
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Created Date: 1996-06-26 Completed Date: 1996-06-26 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1321-6 Citation Subset: AIM; IM |
Affiliation:
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Cardiovascular Thrombosis Research Center, Clinical Trials Section, University of Massachusetts Medical School, Worcester 01655, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Aged Female Heart Rupture, Post-Infarction / mortality* Humans Male Multivariate Analysis Myocardial Infarction / drug therapy*, mortality Registries Sex Factors Shock, Cardiogenic / mortality Thrombolytic Therapy / adverse effects* United States / epidemiology |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 1997 Jan;29(1):221-2
[PMID:
8996319
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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