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.
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.
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.
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.
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.