Key result
Post-STEMI cardiac rupture shows dynamic or recurrent ST elevation in ~87% of patients.
Cohort (n=30)
ST-segment deviations were assessed by an independent physician who was blinded to the patients' clinical information and disease status.
Yes
Cardiac free-wall rupture following STEMI is preceded by a distinctive electrocardiographic evolution—characterized by diffuse new-onset or recurrent ST-segment elevation and dynamic lead AVR ST-segment depression—which should prompt urgent bedside echocardiography for early diagnosis.
These ECG changes may indicate impending post-STEMI rupture; hypothesis-generating and leaves open whether serial monitoring improves detection.
Background Cardiac rupture is a catastrophic complication of ST-segment elevation myocardial infarction (STEMI). Early recognition may be lifesaving and reduce mortality; however, electrocardiographic evidence for early diagnosis remains limited. We aimed to characterize the electrocardiographic features of cardiac rupture in patients presenting with STEMI. Methods This retrospective multicenter cohort study included patients from four hospitals over a 17-year period. Electrocardiograms (ECGs) were obtained at emergency department presentation, performed daily during hospitalization, and repeated as clinically indicated. Dynamic ECG evolution after initial ST-segment resolution was analyzed, including new-onset or recurrent ST-segment elevation and dynamic depression in lead AVR, along with clinical presentation and imaging findings. Results Among the 30 patients diagnosed with cardiac rupture, 26 patients (87%) developed new-onset ST-segment elevation, an equal proportion exhibited recurrent elevation, and 17 (57%) showed dynamic ST-segment depression in lead AVR. Overall, 26 patients (87%) exhibited at least two features, and 13 (43%) demonstrated the full ECG pattern. The median number of leads demonstrating ST-segment elevation decreased from 6 at baseline to 4 prior to rupture, while the median total magnitude declined from 8 to 4 mm. Compared with the pre-rupture phase, the median number of involved leads increased to 8, and total ST-segment elevation to 13.5 mm, indicating more diffuse and pronounced abnormalities. In exploratory analyses, anterior infarction was associated with a greater extent of ST-segment elevation at baseline, reflected by more elevated leads and greater total elevation, but not at cardiac rupture. Conclusions Cardiac rupture following STEMI is characterized by distinctive ECG evolution, including new-onset or recurrent ST-segment elevation with concomitant AVR depression. Recognition of these features should prompt echocardiographic evaluation to enable early diagnosis and timely intervention.
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Yang et al. (2026) conducted a cohort in Left ventricular free-wall cardiac rupture following ST-segment elevation myocardial infarction (STEMI) (n=30). Serial electrocardiography (ECG) monitoring for cardiac rupture was evaluated on Dynamic ECG evolution (new-onset ST-segment elevation, recurrent ST-segment elevation, and dynamic ST-segment depression in lead AVR) prior to clinical deterioration from cardiac rupture (p=<0.001). Cardiac rupture after STEMI exhibited new-onset or recurrent ST-segment elevation in 87% of patients and dynamic AVR depression in 57%, with elevated leads increasing from 4 to 8 (P<0.001).
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