Hutchins Kenneth D, Skurnick Joan, Lavenhar Marvin, Natarajan Geetha A
Regional Medical Examiner Office, Edwin H. Albano Institute of Forensic Sciences, Newark, New Jersey 07103, USA.
Am J Forensic Med Pathol. 2002 Mar;23(1):78-82. doi: 10.1097/00000433-200203000-00017.
Cardiac rupture as a complication of acute myocardial infarction (AMI) has been described as occurring infrequently. Because of the recent dramatic decrease in autopsy rates, the authors believe that current studies do not accurately represent the frequency of this catastrophic complication. Autopsy protocols and archived histologic slides of patients with AMI were retrospectively reviewed to determine whether the frequency of cardiac rupture, as a complication of AMI, is altered when a non-hospital-based patient cohort after autopsy is evaluated. This review yielded 153 cases of 41 women and 112 men, whose postmortem examinations revealed gross and histologic evidence of AMI. Cardiac rupture was present in 30.7% of these cases. Of the 47 patients with rupture, 35 had no relevant medical history. The remaining 12 patients had various medical conditions. None of the patients in the rupture group had previously treated symptoms related to coronary artery conditions. Whereas women constituted 26.8% of the total AMI group, they had a cardiac rupture rate of 61%. By contrast, men with AMI had a cardiac rupture rate of 19.6%. All patients in the cardiac rupture group had heart weights over the predicted expected weight as a function of body weight. Age, gender, and heart weight were significant factors associated with cardiac rupture, whereas body mass index was not significantly related. When these factors were evaluated jointly, age was a significant explanatory factor for rupture among both men and women, whereas body mass index and heart weight were significant for men but not for women. When the rupture sites occurred on the left ventricular myocardium, the anterior wall was affected in 21 cases (45%), the posterior wall in 18 (38%), the lateral wall in 4 (9%), and the apex in 3 (6%). The right ventricular myocardium ruptured in 1 case (2%). Most of the patients had severe multivessel coronary artery disease. Histologic study of the specimens showed that the majority of ruptures occurred between 24 and 72 hours after myocardial infarction. This study showed a frequency of cardiac rupture of 30.7% in patients with AMI and sudden death according to medical examiner's records. These findings confirm and reinforce the importance of postmortem examination and autopsy as an adjunct to clinical medical practice.
心脏破裂作为急性心肌梗死（AMI）的一种并发症，一直被描述为发生率较低。由于近期尸检率急剧下降，作者认为目前的研究未能准确反映这种灾难性并发症的发生频率。对AMI患者的尸检方案和存档组织学切片进行回顾性分析，以确定在评估尸检后非医院患者队列时，作为AMI并发症的心脏破裂发生率是否有所改变。本次回顾共纳入153例患者，其中女性41例，男性112例，尸检显示有AMI的大体和组织学证据。这些病例中30.7%存在心脏破裂。在47例破裂患者中，35例无相关病史。其余12例患者有各种疾病。破裂组患者均无先前治疗过的与冠状动脉疾病相关的症状。女性占AMI总组的26.8%，但其心脏破裂率为61%。相比之下，男性AMI患者的心脏破裂率为19.6%。心脏破裂组所有患者的心脏重量均超过根据体重预测的预期重量。年龄、性别和心脏重量是与心脏破裂相关的重要因素，而体重指数与之无显著相关性。当联合评估这些因素时，年龄是男性和女性破裂的重要解释因素，而体重指数和心脏重量对男性有显著意义，对女性则不然。当破裂部位发生在左心室心肌时，前壁受累21例（45%），后壁18例（38%），侧壁4例（9%），心尖3例（6%）。右心室心肌破裂1例（2%）。大多数患者患有严重的多支冠状动脉疾病。标本的组织学研究表明，大多数破裂发生在心肌梗死后24至72小时之间。根据法医记录，本研究显示AMI和猝死患者的心脏破裂发生率为30.7%。这些发现证实并强化了尸检作为临床医学实践辅助手段的重要性。
