Early cardiac rupture following streptokinase in patients with acute myocardial infarction: Retrospective cohort study

Aim. To assess the incidence and timing of cardiac rupture following strept okinase (SK) administration in acute myocardial infarction (AMI). Methods. We retrospectively analyzed the clinical sheets of AMI patients tr eated at the Coronary Care Unit in University Hospital Split, Croatia, betw een January 1, 1996, and December 31, 1998. We selected the patients who di ed following SK administration (1.5 million U in a 30 min iv. infusion), wi th a discharge diagnosis of "AMI" and "cardiac tamponade - ventricular rupt ure". AMI was defined by typical chest pain, EGG, and/or en zymatic changes . Echo or autopsy verified diagnosis of cardiac tamponade and/or rupture, a s well as pericardial effusion and/or free-wall rupture. Results. Out of 726 AMI patients 136 (18.7%) were treated with SK, and 6 ha d cardiac rupture (4 men and 2 women; 4.4%). Autopsy revealed that 1 patien t had ischemic and 2 had transmural hemorrhagic AMI. Three out of 6 patient s died 2-4, and 3 died 5-7 hours after SK administration. Six patients who died from cardiac rupture (mean age 72.3+/-9.0) were significantly older th an AMI survivors treated with SK (121 patients, mean age 60.5+/-12.0 years, p<0.001). Conclusion. In case of unexplained clinical deterioration in AMI patients o ver 70 during the first hours after SK administration, cardiac tamponade du e to a free-wall rupture should be suspected. SK administration in patients with AMI over 70 years should be a selective and not a routine treatment.