Clinical and instrumental predictors of upcoming cardiac free wall rupture due to acute miocardial infarction

Medical records and autopsy reports of 839 patients admitted to City Hospital N52 were reviewed. 42 patients died from cardiac free wall rupture. Single-factorial analysis was performed to find out the predictors of upcoming cardiac free wall rupture and multi-factorial analysis was performed to determine independent predictors of free wall rupture. A number of cardiac free wall rupture predictors were identified: 1) long-term chest pain (> 1,5 hours); 2) early appearance of Q-wave and rapid inversion of T-wave during first hours of Q-AMI; 3) ST-elevation > 4 mm in two or more ECG leads; 4) prolongation of QRST-complex; 5) ECG evidence of acute interventricular conduction disturbances; 6) hyperkinesias of intact myocardium in accordance with ejection fraction < 40%; 7) aneurysmatic deformation of left ventricle; 8) wall motion score ≥ 2; 9) apical segments involved in infarct area; 10) time of slowing of early diastolic filling ≤ 150 ms. Independent predictors of cardiac free wall rupture were the following: 1) hyperkinesias of intact myocardium in accordance with ejection fraction < 40%; 2) apical segments involved in infarct area; 3) time of slowing of early diastolic filling ≤ 150 ms; 4) refractory sinus tachycardia; 5) age > 75 years; 6) primary Q-AMI; 7) ST-elevation > 4 mm in two or more ECG leads. Early cardiac free wall rupture due to acute Q-AMI could be predicted with the help of anamnestic, clinical and instrumental data analysis.