Characteristics Of Patients With Left Ventricular Free Wall Rupture Related Death In Acute Myocardial Infarction Setting: A Retrospective Ananlysis Of Patients From A Single Tertiary Cardiac Centre.

Abstract

Introduction: Left Ventricular free wall rupture (LVFWR) is a lethal and rare complication of acute
myocardial infarction (AMI). LVFWR accounts for 8–17% of mortality in STEMI patients. Characteristics,
predisposing factors which are vital in preventing this complication are yet to be studied well.
Objective: To study the characteristics and predisposing factors of patients with LVFWR related death in
AMI setting.
Methods:All AMI patients, whose death is documented to be due to primarily LVFWR, were included in
the study. Patient’s demographic data, risk/precipitating factors, clinical characteristics, in-hospital course,
revascularization strategies, and angiographic data were collected from our institutional database.
Results: A total of 69 patients with LVFWR related deaths were identified. Mean age of the study subjects
was 65.32 years. 36 patients were females, 33 were males. 40% of subjects were in the age group of 61-70
years. Hypertension is the most common associated risk factor seen in 55% patients. Mean duration of
presentation since the onset of symptoms is around 23 hours. Thirty patients (43%) presented in a state of
cardiogenic shock. Beta blockers could be initiated in just above 20% of patients. Majority of patients
(71%) received thrombolysis. Majority had single vessel disease (61% of those who underwent angiogram).
LAD was the most common Culprit vessel seen in 8 out of 13 angiograms (61.5%).
Conclusion: Classical risk factors of LVFWR like advanced age, female gender, delayed
presentation,presence of hypertension; first acute MI and cardiogenic shock at the time of presentation were
well appreciated. Majority of LVFWR patients had single vessel disease predominantly left anterior
descending artery disease. Majority had undergone thrombolysis.