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Clinical characteristics and protective factors in patients with acute myocardial infarction undergoing in-hospital myocardial free wall rupture: a single-center, retrospective analysis
  1. Bowen Lou1,2,3,
  2. Yongbai Luo1,2,
  3. Xiang Hao1,2,
  4. Lizhe Sun1,2,
  5. Yangyang Deng1,2,
  6. Manyun Guo1,2,
  7. Junhui Liu4,
  8. Bo Zhou5,
  9. Zuyi Yuan1,2,
  10. Jianqing She1,2
  1. 1 Cardiovascular Department, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
  2. 2 Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an, China
  3. 3 Present Address: European Center for Angioscience (ECAS), Department of Vascular Biology&Tumor Angiogenesis, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
  4. 4 Diagnostic Department, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
  5. 5 Respiratory Department, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
  1. Correspondence to Dr Jianqing She, Xi’an Jiaotong University, Xi’an 12480, China; jianqingshe{at}


Myocardial free wall rupture (MFWR) refers to laceration of the heart ventricle or atria, which is a rare but fatal complication of acute myocardial infarction (AMI). In this study, we aim to identify the clinical characteristics and protective factors of free wall rupture after myocardial infarction. This is a single-center, retrospective observational analysis. The study screened all patients admitted to the cardiology department of the First Affiliated Hospital of Xi’an Jiaotong University between January 2013 and April 2018. The biochemical, clinical, angiographic and echocardiographic features of these patients were then collected and analyzed. Among the 5946 screened patients with AMI, 23 patients with a diagnosis of MFWR after AMI were enrolled in the present study. 18 (78.3%) patients were diagnosed with acute ST segment elevated myocardial infarction and the remaining 5 (21.7%) have acute non-ST segment elevated myocardial infarction. Early-phase MFWR happened in 12 (52.2%) and late-phase accounted for 8 (34.8%) in total. Late-phase MFWR had lower left ventricle ejection fraction value (45.8%±5.6% vs 63.0±3.8%, p<0.001) as compared with early-phase. Patients who survived from MFWR has higher ACE inhibitor/angiotensin II receptor blocker (ACEI/ARB) and β-blocker coverage in the in-hospital treatment of AMI (ACEI/ARB: 100.0% vs 35.3%, p=0.014; β-blocker: 100.0% vs 47.1%, p=0.048). The present study provides evidence for better understanding of the clinical characteristics and protective functions in MFWR after AMI. Reduced cardiac function is correlated with higher incidence of later phase free wall rupture. Higher ACEI/ARB and β-blocker coverage in the AMI treatment strategy is associated with lower MFWR incidence.

  • myocardial free wall rupture
  • acute myocardial infarction
  • clinical characteristics
  • protective factors

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  • Contributors JS and ZY designed the study. BL, YL, XH, LS, YD, MG and JL collect the data. JS and BZ analyzed the data. JS and BL wrote the paper.

  • Funding This study was supported by the National Natural Science Foundation of China (81500219, 81400302, 81570406), the Natural Science Foundation of Shaanxi Province (2018KW067, 2017JM8016, 2016SF217), the Fundamental Research Funds for the Central Universities in China (1191329724, 191329849), and the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University, China (no XJTU1AF-CRF-2018-025).

  • Competing interests None declared.

  • Ethics approval The study was approved by the ethics committee of the hospital. Because of the retrospective nature of the study, informed consent was not deemed necessary.

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

  • Patient consent for publication Not required.

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