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Fatal myocardial rupture after acute myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: the VALsartan In Acute myocardial iNfarcTion Trial (VALIANT).
Am Heart J. 2010 Jul; 160(1):145-51.AH

Abstract

BACKGROUND

Myocardial rupture is a relatively rare and usually fatal complication of myocardial infarction (MI). Early recognition of patients at greatest risk of myocardial rupture provides an opportunity for early intervention.

METHODS

VALIANT was a double-blind, randomized, controlled trial comparing valsartan, captopril, and their combination in high-risk patients post-MI. Myocardial rupture was identified by autopsy (available in 138/589 patients dying within 30 days of index MI), echocardiography, direct surgical visualization, or presence of hemopericardium. An independent clinical end points committee reviewed medical records for all deaths or suspected nonfatal cardiovascular events.

RESULTS

Rupture was identified in 45 (0.31%) patients enrolled in VALIANT, occurring 9.8 +/- 6.0 days after the qualifying MI. Rupture accounted for 7.6% (45/589) of all deaths occurring in the first 30 days of follow-up and 24% (33/138) of deaths in which autopsies were obtained. Compared with survivors, rupture was associated with increased age, hypertension, increased Killip class, lower estimated glomerular filtration rate, and Q wave MI, and inversely related to beta-blocker and diuretic use. Compared with patients who died of other causes within 30 days, patients with myocardial rupture were more likely to have had an inferior MI, Q wave MI, or hypertension; to have used oral anticoagulants; or to have received thrombolytic therapy.

CONCLUSIONS

Although rare, myocardial rupture accounted for nearly one fourth of all deaths within the first 30 days after high-risk MI, suggesting an estimated incidence of approximately 1% within the first 30 days. A number of clinical characteristics may identify post-MI patients at higher risk of myocardial rupture.

Authors+Show Affiliations

Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

20598985

Citation

Shamshad, Faisal, et al. "Fatal Myocardial Rupture After Acute Myocardial Infarction Complicated By Heart Failure, Left Ventricular Dysfunction, or Both: the VALsartan in Acute Myocardial iNfarcTion Trial (VALIANT)." American Heart Journal, vol. 160, no. 1, 2010, pp. 145-51.
Shamshad F, Kenchaiah S, Finn PV, et al. Fatal myocardial rupture after acute myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: the VALsartan In Acute myocardial iNfarcTion Trial (VALIANT). Am Heart J. 2010;160(1):145-51.
Shamshad, F., Kenchaiah, S., Finn, P. V., Soler-Soler, J., McMurray, J. J., Velazquez, E. J., Maggioni, A. P., Califf, R. M., Swedberg, K., Kober, L., Belenkov, Y., Varshavsky, S., Pfeffer, M. A., & Solomon, S. D. (2010). Fatal myocardial rupture after acute myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: the VALsartan In Acute myocardial iNfarcTion Trial (VALIANT). American Heart Journal, 160(1), 145-51. https://doi.org/10.1016/j.ahj.2010.02.037
Shamshad F, et al. Fatal Myocardial Rupture After Acute Myocardial Infarction Complicated By Heart Failure, Left Ventricular Dysfunction, or Both: the VALsartan in Acute Myocardial iNfarcTion Trial (VALIANT). Am Heart J. 2010;160(1):145-51. PubMed PMID: 20598985.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fatal myocardial rupture after acute myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: the VALsartan In Acute myocardial iNfarcTion Trial (VALIANT). AU - Shamshad,Faisal, AU - Kenchaiah,Satish, AU - Finn,Peter V, AU - Soler-Soler,Jordi, AU - McMurray,John J V, AU - Velazquez,Eric J, AU - Maggioni,Aldo P, AU - Califf,Robert M, AU - Swedberg,Karl, AU - Kober,Lars, AU - Belenkov,Yuri, AU - Varshavsky,Sergei, AU - Pfeffer,Marc A, AU - Solomon,Scott D, AU - ,, PY - 2009/07/11/received PY - 2010/02/24/accepted PY - 2010/7/6/entrez PY - 2010/7/6/pubmed PY - 2010/8/18/medline SP - 145 EP - 51 JF - American heart journal JO - Am Heart J VL - 160 IS - 1 N2 - BACKGROUND: Myocardial rupture is a relatively rare and usually fatal complication of myocardial infarction (MI). Early recognition of patients at greatest risk of myocardial rupture provides an opportunity for early intervention. METHODS: VALIANT was a double-blind, randomized, controlled trial comparing valsartan, captopril, and their combination in high-risk patients post-MI. Myocardial rupture was identified by autopsy (available in 138/589 patients dying within 30 days of index MI), echocardiography, direct surgical visualization, or presence of hemopericardium. An independent clinical end points committee reviewed medical records for all deaths or suspected nonfatal cardiovascular events. RESULTS: Rupture was identified in 45 (0.31%) patients enrolled in VALIANT, occurring 9.8 +/- 6.0 days after the qualifying MI. Rupture accounted for 7.6% (45/589) of all deaths occurring in the first 30 days of follow-up and 24% (33/138) of deaths in which autopsies were obtained. Compared with survivors, rupture was associated with increased age, hypertension, increased Killip class, lower estimated glomerular filtration rate, and Q wave MI, and inversely related to beta-blocker and diuretic use. Compared with patients who died of other causes within 30 days, patients with myocardial rupture were more likely to have had an inferior MI, Q wave MI, or hypertension; to have used oral anticoagulants; or to have received thrombolytic therapy. CONCLUSIONS: Although rare, myocardial rupture accounted for nearly one fourth of all deaths within the first 30 days after high-risk MI, suggesting an estimated incidence of approximately 1% within the first 30 days. A number of clinical characteristics may identify post-MI patients at higher risk of myocardial rupture. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/20598985/Fatal_myocardial_rupture_after_acute_myocardial_infarction_complicated_by_heart_failure_left_ventricular_dysfunction_or_both:_the_VALsartan_In_Acute_myocardial_iNfarcTion_Trial__VALIANT__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(10)00334-0 DB - PRIME DP - Unbound Medicine ER -