Abstract 10444: New Predictors and Long-Term Outcomes in ST-Elevation Myocardial Infarction with Cardiac Rupture After Primary Percutaneous Coronary Intervention

Introduction: Cardiac rupture (CR) is a serious complication of acute myocardial infarction. Primary percutaneous coronary intervention (pPCI) reduces the incidence of CR. However, the risk factors and long-term outcomes in patients with CR after pPCI remain unclear. Aims: To investigate the clinical predictors and outcomes of CR after pPCI. Methods: This was a retrospective, case-control, multi-center study. A total of 2,444 consecutive patients with ST-elevation myocardial infarction (STEMI) undergoing pPCI from 2009 to 2015 were included; 33 patients had CR (1.4%): 19 were assigned as early-CR (≤72 h) and 14 as late-CR (>72 h). The 132 controls (non-CR) were randomly selected by matching the 2,411 STEMI patients without CR at a 1:4 ratio. Results: Figure.1 showed that female, acute hyperglycemia, thrombocytopenia (platelet<15х10 4 /μL), and incomplete revascularization (post-PCI thrombolysis in myocardial infarction [TIMI]<3) were independent risk factors for CR (P<0.05). Univariate logistic regression after adjusting age and sex showed that acute hyperglycemia and post-PCI TIMI<3 were significantly associated with early-CR, whereas thrombocytopenia was strongly associated with late-CR. In-hospital mortality rate was significantly higher in the CR than the non-CR group (66.7% vs 6.8%, P<0.0001). Emergency surgical repair exhibited a strong association with in-hospital death. Kaplan-Meier survival curve in Figure.2 showed no significant difference between surviving STEMI patients with CR and non-CR (Log-rank P=0.26). Conclusions: Acute hyperglycaemia and thrombocytopenia are new predict factors for early- and late-CR, respectively. The clinical risk factors of early- and late-CR in pPCI era may differ. Emergency surgical repair affects with in-hospital mortality, and surviving CR patients have a similar post-discharge survival rate compared with surviving non-CR patients.