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Risk factors for cardiac rupture complicating myocardial infarction: a PRISMA meta-analysis and systematic review
  1. Wen Hao1,
  2. Shangxin Lu2,
  3. Ruifeng Guo1,
  4. Jingyao Fan1,
  5. Lei Zhen1,
  6. Shaoping Nie1
  1. 1 Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
  2. 2 Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Dr Shaoping Nie, Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; spnie{at}


Cardiac rupture (CR) is a complication of acute myocardial infarction (AMI) that is associated with a high mortality rate. This study aimed to identify the risk factors for CR in patients with AMI. Medline, Cochrane, EMBASE, and Google Scholar databases were searched for relevant literature published through September 16, 2018. Eligible studies included patients with AMI and compared factors between patients with and without CR. Sixteen studies were identified and included in the meta-analysis. Results revealed that female gender (pooled OR=2.72, 95% CI 2.04 to 3.63, p<0.001), older age (pooled difference in means=6.91, 95% CI 4.20 to 9.62, p<0.001), infarction at left anterior descending coronary artery (LAD) (pooled OR=1.85, 95% CI 1.03 to 3.32, p=0.039), and anterior wall infarction (pooled OR=1.87, 95% CI 1.30 to 2.68, p=0.001) were associated with increased risk of CR, whereas history of MI, smoking, and multivessel disease were associated with reduced risk of CR. Patients treated with primary percutaneous coronary intervention (PCI) had reduced risk of CR, while patients who had received any thrombolysis had increased risk of CR. In conclusion, results of systematic review and meta-analysis of existing literature suggest that risk factors for CR in patients with AMI include female gender, older age, new-onset MI, non-smoking status, LAD infarction, anterior wall infarction, and single-vessel disease. Furthermore, treatment with primary PCI may help reduce the risk for CR, while thrombolysis might increase the risk for CR.

  • cardiovascular diseases

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  • Contributors SN contributed to study design. WH contributed to literature research and manuscript preparation. SL contributed to literature research. JF and LZ contributed to data acquisition and analysis.

  • Funding This study was supported by the Beijing Natural Science Foundation (7141003), the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (ZYLX201710) and the Cardiovascular Disease Big Data Platform Development and Applied Research Project (2015AA020102).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.