Predictive factors of cardiac rupture in patients with ST-elevation myocardial infarction

Cardiac rupture （CR） is a potentially fatal mechanical complication of ST-elevation myocardial infarction （STEMI）. We aimed to determine the incidence and risk factors of CR in Chinese STEMI patients. A total of 9798 consecutive STEMI patients from four centers in China were retrospectively analyzed, among which 178 patients had CR. STEMI patients without CR were chosen as a control group. Clinical characteristics were compared between STEMI patients with CR and those without CR. The incidence of CR in STEMI patients was 1.82%, and the 30-d mortality was up to 61.2%. CR patients were significantly older, more female, and associated with a longer time from onset of pain to hospital admission than their non-CR counterparts （P〈0.001）. More patients with anterior myocardial infarction （82.1%） were found in the CR group, and CR patients had significantly higher heart rates than the control group （（91±19） bpm vs. （71±16） bpm; P〈0.001）. In multiple-adjusted models, the independent risk factors of CR were advanced age, female gender, anaemia, increased heart rate, anterior myocardial infarction, increased white blood cell （WBC） count, delayed admission, and renal dysfunction. The level of hemoglobin remained a significant deter- minant factor of CR （OR （95% CI）： 0.82 （0.75-0.89）; P〈0.001） after adjusting for various potential confounding factors. Counts of WBC also remained a significant determinant of the CR （OR （95% CI）： 1.08 （1.04-1.12）; P〈0.001）. A number of variables were independently related to CR. This study indicated, for the first time, that both hemoglobin and WBC levels were independently correlated with occurrence of CR.

Successful emergency surgical intervention in acute non-STsegment elevation myocardial infarction with rupture:A case report

BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.

Uncommon post-infarction pseudoaneurysms:A case report

BACKGROUND Mechanical complications are a rare presentation in chronic coronary syndromes,which have significantly decreased in the primary coronary intervention era.Incomplete rupture may occur,resulting in pseudoaneurysms(PANs).Early reperfusion decreases the risk of this complication.Echocardiography is the method of choice for diagnosis.CASE SUMMARY A 54-year-old female hypertensive patient,with a history of non-revascularized inferior and anterior ST-segment elevation myocardial infarction(MI)4 years prior,was admitted to the cardiac unit of the hospital with complaints of abdominal pain and dyspnea lasting 2 mo.The patient was hemodynamically stable,and 12-lead electrocardiogram showed persistent ST elevation and Q wave in the inferior and apical regions.Transthoracic echocardiogram in the twochamber view showed a narrow neck of a wide PAN in the distal apical left ventricular inferior wall.In addition,the apical four-chamber and subcostal views revealed a second bulky PAN of the apical wall separated from the first by a common organizing thrombus.Cardiac magnetic resonance imaging confirmed the coexistence of more than one PAN.The patient received conservative medical treatment,and surgery was scheduled for outside the country.The patient had worsening multiple organ failure and died 4 wk after presentation.CONCLUSION Multifocal PANs rarely occur in chronic MI.Attention should be paid to patients with pain and cardiovascular risk factors.

Fatal Cardiac Tamponade following Road Traffic Accident

Cardiac tamponade following blunt trauma results from cardiac rupture,leading to death even before the patient can receive medical attention.In such cases,the collected fluid(blood)in the pericardium inhibits the diastolic filling compressing the myocardium resulting in obstructive shock.We are reporting the case report of a 30-year-old male who was brought dead to the hospital with a history of road traffic accidents.The investigating officer informed that the deceased driver was not wearing a seat belt.Autopsy findings showed fresh blood clots of 600 g in the pericardial sac with rupture of the left ventricular wall of the heart.There were contusions on the anterior aspect of the vertebrae corresponding to the heart level.Although it is impossible to prevent all the cases of cardiac tamponade,we can avoid the ones resulting from trauma.This case intends to stress the importance of wearing a seat belt while driving a car to prevent fatal injuries.