A meta-analysis of risk factors for cardiac rupture complicated with acute myocardial infarction

Cardiac rupture (CR) is a dangerous mechanical complication after acute myocardial infarction (AMI). This study aimed to determine the risk factors for CR in patients with AMI and provide insights into the prevention and treatment of CR. We searched seven databases for literature published from 2000 to 2023. We performed a meta-analysis of participant data from 46 case-control studies from 10 countries. All participants were diagnosed with AMI, and the number of CR patients ranged from 11 to 408, totaling 3,305. A meta-analysis of 46 included studies showed that females [OR = 2.55, 95%CI (2.18,2.99), P < 0.001], patients with anterior wall MI [OR = 1.76, 95%CI (1.44,2.14), P < 0.001] and patients with previous stroke [OR = 1.49, 95%CI (1.06,2.09), P = 0.022] were at high risk for CR. Patients with previous MI had a reduced risk of CR during reinfarction [OR = 0.58, 95%CI (0.48,0.69), P < 0.001]. Patients treated with β-blockers, Angiotensin-converting enzyme inhibitor (ACEI) / Angiotension II receptor blocker (ARB), or primary percutaneous coronary intervention (PCI) had a lower risk of getting cardiac rupture after AMI. AMI patients with CR were often accompanied by advanced age, increased white blood cells, and decreased hemoglobin and hematocrit. Multivariate analysis showed consistent results: Female gender, advanced age, anterior wall myocardial infarction, and increased WBC level were risk factors for CR, while ACEI/ARB and primary PCI could reduce the risk of CR. Female gender, advanced age, anterior wall myocardial infarction, and elevated white blood cell level are risk factors for CR. Primary PCI, ACEI/ARB, and β-blockers are associated with a lower incidence of cardiac rupture.