Myocardial rupture as a cause of sudden cardiac death following STEMI

Despite implantation of AICDs, there remains a high incidence of sudden death following ST elevation MI. This is due to the fact that not all sudden death is due to arrythmias in the period following ST elevation MI. Based upon autopsy findings, the relative frequency of various pathophysiologic events among 105 cases was as follows^[1]:

• 3 Index MIs in the first 7 days (2.9%)
• 28 Recurrent MIs (26.6%)
• 13 Cardiac ruptures (12.4%)
• 4 Pump failures (3.8%)
• 2 Other cardiovascular causes (stroke or pulmonary embolism; 1.9%)
• 1 Noncardiovascular cause (1%)
• 54 cases (51.4%) had no acute specific autopsy evidence other than the index MI and were thus presumed arrhythmic.

The relative contribution of arrhythmic death was lowest in the first month, while the relative contribution of recurrent MI or cardiac rupture was highest in the first month following ST elevation MI. After three months, however, the relative contribution shifted so that the proportion of cases attributable to arrhythmias was significantly higher than recurrent MI or rupture (P<0.0001).

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