Long-term outcome and risk prediction in patients suffering acute myocardial infarction complicated by post-infarction cardiac rupture.

BACKGROUND: Post-infarction cardiac rupture (CR) such as ventricular septal rupture (VSR), free wall rupture (FWR), atrial septal rupture (ASR) or papillary muscle rupture (PMR) is a rare but dreaded complication in patients with acute myocardial infarction (AMI) associated with a very poor prognosis with reported mortality rates between 60 and 100%. Therefore suitable risk stratification for secondary prevention seems crucial, but data on long-term survival und risk prediction in this especially vulnerable patient collective remains scarce.
METHODS: Out of 11,641 patients presenting with AMI a total of 28 individuals suffering post-infarction CR were identified and stratified in "acute survivors of CR" (n=10) and "non-survivors of CR" (n=18). Cox regression hazard analysis was used to assess prognosticators on long-term survival.
RESULTS: Ten patients (35.7%) survived the initial event. After a median follow-up time of 9years 2 (20%) of the survivors died, both due to cardiovascular causes. Younger age (p=0.023) and higher systolic blood pressure at admission (p=0.018) turned out to be significant predictors of long-term survival. Systolic blood pressure 48h after CR proved to be a strong and independent predictor for survival with an adjusted hazard ratio per one standard deviation of 0.89 (95% CI: 0.72-0.99; 0.048).
CONCLUSION: Hemodynamic stabilization and severity of cardiogenic shock were detected as clinically most common among patients suffering post-infarction CR and proved to be of major importance for survival. If survival of the initial event was achieved, satisfying long-term mortality could be reached.