RELEVANCE OF DELAYED HOSPITAL ADMISSION ON DEVELOPMENT OF CARDIAC RUPTURE DURING ACUTE MYOCARDIAL-INFARCTION - STUDY IN 225 PATIENTS WITH FREE-WALL, SEPTAL OR PAPILLARY-MUSCLE RUPTURE

Objectives. We analyzed the possible relation between the presence of a hospital admission delay (greater than or equal to 24 h), undue phys ical effort or recurrence of anginal pain, alone or in combination, wi th the development of free wall rupture (FWR), septal rupture (SR) or papillary muscle rupture (PMR) in patients,vith an acute myocardial in farction (AMI). Background. Physical activity as a trigger of FWR in A MI remains controversial, and its contribution to SR or PMR remains un known. Moreover, the role of ischemia or reinfarction as an additional cause of rupture has not been explored.Methods. The incidence of hosp ital admission delay greater than or equal to 24 h with maintenance of some ambulatory activity and the incidence of postinfarction angina , were analyzed in consecutive patients with a first AMI,vith (n = 225) or without rupture (n = 1,012 [control group]) over different time per iods. Results. An admission delay greater than or equal to 24 h occurr ed in 27 (27.6%) of 98 patients with FWR, 47 (47.0%) of 100 with SR an d 14 (51.9%) of 27 with PMR but in only 81 (8%) of 1,012 control patie nts (p < 0.0001). Information on undue in-hospital effort preceding ru pture was available for 111 patients and was present in 17 (32.7%) of 52 with FWR, 9 (18.4%) of 49 with SR and 3 (30%) of 10 with PMR versus only 76 (7.5%) of 1,012 control patients (p < 0.001). Information on postinfarction anginal pain was available for 114 patients with ruptur e and occurred in 30 (56.6%) of 53 with FWR, 30 (60%) of 50 with SR an d 4 (36.4%) of 11 with PMR versus 120 (11.9%) of 1,012 control patient s (p < 0.0001). Mean age and incidence of male gender, hypertension, a bsence of heart failure, single vessel disease or occlusion of the inf arct related artery were comparable among the groups with FWR, SR or P MR. Conclusions. Delayed hospital admission or undue in hospital physi cal activity appears to increase the risk of rupture in patients prone to this complication (i.e., a first transmural AMI, absence of overt heart failure and advanced age); recurrence of ischemia/infarction eme rges as a potential additional trigger in a proportion of these patien ts. (C) 1998 by the American College of Cardiology.