Free wall rupture following rescue angioplasty and intravenous abciximab for failed thrombolysis

Early thrombolytic therapy reduces the risk of cardiac rupture but delayed thrombolysis may increase this risk, despite improving overall survival. Th e mechanism appears to be related to both unsuccessful early reperfusion an d haemorrhagic transformation following delayed reperfusion. The effect of antiplatelet therapy with glycoprotein IIb-IIIa receptor blockers (abcixima b) on cardiac rupture is unknown. It is possible that they may contribute t o cardiac rupture by promoting haemorrhagic transformation of [lie infarcte d area. In this report we describe a 57 year old man who underwent emergenc y coronary angioplasty and stenting following jailed thrombolytic therapy f or an acute anterior in myocardial infarction. A suboptimal result was obta ined which necessitated an intravenous bolus of abciximab followed by an in fusion. He abruptly, developed electromechanical dissociation. Echocardiogr am confirmed pericardial tamponade and a pericardial drain it-as inserted b ut the patient could not be resuscitated. Postmortem examination confirmed a large transmural rupture of the infarcted anterior wall which had undergo ne haemorrhagic transformation.