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Comparison in Prevalence, Predictors, and Clinical Outcome of VSR Versus FWR after Acute Myocardial Infarction: The Prospective, Multicenter Registry MOODY Trial-Heart Rupture Analysis
- Source :
- Cardiovascular revascularization medicine : including molecular interventions. 20(12)
- Publication Year :
- 2018
-
Abstract
- Background Differences in the predictors between ventricular septal rupture (VSR) and free wall rupture (FWR) have not been fully studied. Data on the prevalence and clinical outcome of heart rupture are limited. Hypothesis This study aimed to investigate heart rupture incidence and clinical results in patients with acute myocardial infarction (AMI). Methods Of 9265 AMI patients in the MOODY registry between March 1999 and October 2016, a total of 146 were studied. The primary clinical endpoint was rupture prevalence and in-hospital mortality. Independent factors of heart rupture were analyzed using Cox proportional model and were compared between patients with VSR and those with FWR. Results Of 9265 AMI patients, 146 (1.58%) patients had a heart rupture (FWR, 94 (1.02%)) and VSR (52 (0.56%)). All patients with FWR died during hospitalization, and in-hospital mortality was recorded in 37 (71.2%) patients with VSR, who had an extremely longer time delay from AMI onset to the first medical contact (FMC) (~20 h). FWR usually occurred in patients with ST-elevation myocardial infarction (STEMI) patients with a FMC ≥ 3 h, for whom primary reperfusion was not performed. Percutaneous repair at 1–2 weeks following AMI was associated with less mortality, and 9 of 38 patients who underwent non-primary reperfusion died post procedure. Conclusion This study demonstrated the importance of shortening FMC to prevent VSR and of early primary reperfusion in STEMI patients to reduce FWR. Urgent closure of rupture is necessary to reduce in-hospital and 1-year mortality. Clinical trial registration http://www.clinicaltrials.org , identifier: No. NCT03051048.
- Subjects :
- Male
medicine.medical_specialty
Cardiac Catheterization
China
Time Factors
Septal Occluder Device
Heart Rupture
Myocardial Infarction
030204 cardiovascular system & hematology
Risk Assessment
Free wall
Time-to-Treatment
Ventricular Septal Rupture
03 medical and health sciences
0302 clinical medicine
Percutaneous Coronary Intervention
Risk Factors
Internal medicine
Clinical endpoint
Prevalence
Medicine
Humans
In patient
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Hospital Mortality
Prospective Studies
Registries
Aged
Heart Rupture, Post-Infarction
Aged, 80 and over
business.industry
Incidence (epidemiology)
Incidence
General Medicine
Middle Aged
medicine.disease
Clinical trial
Treatment Outcome
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 18780938 and 03051048
- Volume :
- 20
- Issue :
- 12
- Database :
- OpenAIRE
- Journal :
- Cardiovascular revascularization medicine : including molecular interventions
- Accession number :
- edsair.doi.dedup.....d95cf3c5b37e7de2f63aa19d1daf78f6