Free wall rupture (FWR) in patients with acute ST-elevation myocardial infarction (STEMI) receiving fibrinolytic therapy (FT): A 7-year prospective study

2012 ◽  
Vol 54 (1) ◽  
pp. 266-270 ◽  
Author(s):  
Katarina Novak ◽  
Stojan Polic ◽  
Vesna Capkun ◽  
Damir Fabijanic ◽  
Ajvor Lukin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Prospective Study ◽  
Fibrinolytic Therapy ◽  
St Elevation Myocardial Infarction ◽  
Free Wall ◽  
Free Wall Rupture ◽  
St Elevation

scholarly journals P1482 Surviving free wall rupture

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Pomiato ◽  
P Milewski ◽  
A Comunello ◽  
E Schoepf ◽  
R Oberhollenzer ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Coronary Angiography ◽  
Multimodality Imaging ◽  
Interventricular Septum ◽  
St Elevation Myocardial Infarction ◽  
Free Wall ◽  
Free Wall Rupture ◽  
St Elevation ◽  
Anterior Septum

Abstract Introduction Free wall cardiac rupture (CR) is a rare event accounting for 0.1–0.3% of the patients suffering acute myocardial infarction. Its outcome is very poor and it is the third most common cause of early mortality after hospitalization for ST Elevation Myocardial Infarction (STEMI). Purpose We report a case of a 63 years-old woman surviving a free wall rupture after ST Elevation Myocardial Infarction. Methods The patient was referred to our cath-lab to undergo primary PCI in ST elevation myocardial infarction. Results Coronary angiography showed long thrombotic occlusion of left anterior descendent (LAD) artery and critical stenosis of posterior descending artery. The CULPRIT lesion on the anterior descending artery was treated with angioplasty and implantation of three drug eluting stents (3.0x31 mm; 2.75x15 mm; 2.5x30 mm). Twenty four hours later the patient developed a double cardiac arrest with pulseless electrical activity, which were immediately managed with ALS protocol. The patient recovered both time within a couple of minutes and point-of-care transthoracic echocardiogram (TTE) showed a newly developed circumferential pericardial effusion (maximum diastolic diameter 9 mm), associated to a significant thinning of the anterior interventricular septum. A fibrin clot was tamponating a suspected free wall rupture. Emergent coronary angiography showed an in-stent thrombosis but failed to restore adequate blood flow in the LAD artery. In the following days, the patients developed cardiogenic shock handled with i.v. dobutamine and intra-aortic balloon pump (IABP). Only after day 10 hemodynamic parameters started to improve gradually, allowing IABP removal and finally discharge on day 30. A second TTE, performed on day 7, confirmed massive necrosis of the anterior wall with severely reduced ejection fraction (EF 22%), pericardial thrombus and aneurismatic evolution of the apex and the mid-anterior septum. To support our finding we performed a cardiac magnetic resonance which confirmed missing ventricular wall at the anterior apex. It also showed transmural late gadolinium enhancement (LGE) of the anterior mid-apical septum and of the apex and a huge pericardial thrombus encompassing the whole mid-anterior septum (Figure 1, a-f). Before discharge the patient underwent two cardiac surgery visits which contraindicated surgical treatment in the acute phase. Therefore she was sent to cardiac rehabilitation program. Six months later, the patient finally underwent cardiac surgery and the covered free wall rupture was confirmed in the operating theatre. Conclusion This is a very rare case of covered free wall rupture, treated 6 months after the acute event. Multimodality imaging was essential to confirm the diagnosis and to guide the following management. Abstract P1482 Figure 1

scholarly journals Neutrophil Counts Help Predict Free Wall Rupture Following St-elevation Myocardial Infarction

2021 ◽  
Vol 44 (2) ◽  
pp. E62-70
Author(s):  
Wei Gong ◽  
Siyi Li ◽  
Yan Yan ◽  
Hui Ai ◽  
Xiao Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
St Elevation Myocardial Infarction ◽  
Control Group ◽  
Free Wall ◽  
Free Wall Rupture ◽  
Laboratory Test Results ◽  
Significant Difference ◽  
St Elevation

Purpose: Free wall rupture (FWR) is a lethal complication after acute myocardial infarction; however, the un-derlying mechanisms of FWR are unclear. This study analyzes the relationship between neutrophil counts and FWR following ST-elevation myocardial infarction (STEMI). Methods: The case group was STEMI patients with FWR and the control group was STEMI patients without FWR (case-control ratio was 1:4). The demographic data, clinical manifestation and laboratory test results were retrospectively collected and analyzed. Results: Of a total of 6,712 consecutive STEMI patients, 78 patients (1.2%) had FWR. Compared with STEMI patients, patients with FWR were older and more likely to be female with an anterior infarct. White blood cell (WBC) counts were significantly higher in the FWR group. Moreover, we found that the elevated neutrophil counts mainly accounted for the elevated WBC counts. There was also a correlation between the age and neu-trophil counts (P=0.0109); as patient age increased, neutrophil counts decreased (P=0.0387). We also found no correlation between neutrophil counts and the time between myocardial infarction attack and FWR; however, when dividing these patients into FWR ≤48 h after admission to hospital for STEMI and FWR >48 h, there was a significant difference in neutrophil counts (P=0.0196). Furthermore, the results of logistic regression analy-sis showed that increased neutrophil was an independent risk factor for FWR (odds ratio: 2.404, confidence interval: 1.055-5.477). Conclusion: Elevated neutrophil counts were found to be the main cause of differences in WBC counts be-tween FWR and STEMI. Elevated neutrophil was an independent risk factor for FWR. This study provided clues for further research and development of therapeutics for the prevention of FWR.

scholarly journals The impact of diabetes on electrocardiographic ST resolution and clinical outcome of acute ST elevation myocardial infarction following fibrinolytic therapy

Cor et Vasa ◽  
2016 ◽  
Vol 58 (6) ◽  
pp. e584-e590
Author(s):  
Mir Milad Pourmousavi ◽  
Arezou Tajlil ◽  
Behzad Rahimi Darabad ◽  
Laleh Pourmousavi ◽  
Leili Pourafkari ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcome ◽  
Fibrinolytic Therapy ◽  
St Elevation Myocardial Infarction ◽  
St Elevation ◽  
The Impact
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