{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T05:00:36Z","timestamp":1781067636383,"version":"3.54.1"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardiac rupture (CR) is a fatal mechanical complication of acute myocardial infarction (AMI) with mortality rates exceeding 50%. Early identification of high-risk patients remains clinically important, especially in regions with delayed presentation and limited contemporary data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective case-control study included 71 unique patients with CR [free wall rupture (FWR) 39, ventricular septal rupture (VSR) 28, papillary muscle rupture (PMR) 4] and 213 AMI controls without mechanical complications (1:3 ratio, stratified by AMI type) from a tertiary hospital in Wuhan, China (June 2020\u2013December 2025). Factors independently associated with CR were identified using multivariable logistic regression with the events-per-variable principle (\u226510). Model discrimination was assessed by the C-statistic and calibration by the Hosmer-Lemeshow test. Subtype comparisons (FWR vs. VSR), early (\u22643 days) vs. late (&amp;gt;3 days) rupture analysis, and in-hospital mortality correlates were also evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients with CR were older (69.6\u2009\u00b1\u20098.5 vs. 59.5\u2009\u00b1\u200911.7 years,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), more frequently female (40.8% vs. 12.2%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), and had longer onset-to-door times (median 48 vs. 5\u2005h,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). In multivariable analysis, absence of emergency percutaneous coronary intervention (PCI) [odds ratio (OR)\u2009=\u20098.23, 95% confidence interval (CI) 3.45\u201319.66], Killip class III\u2013IV (OR\u2009=\u20096.82, 95% CI 2.68\u201317.35), female sex (OR\u2009=\u20093.41, 95% CI 1.41\u20138.26), and lower serum albumin (OR\u2009=\u20090.84\u2005per g\/L, 95% CI 0.77\u20130.91) were independently associated with CR. FWR showed markedly higher mortality than VSR (97.4% vs. 57.1%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Early rupture (\u22643 days, 39.4%) was associated with more intense inflammatory activation and higher admission troponin, whereas late rupture (&amp;gt;3 days, 60.6%) was associated with lower albumin and markedly delayed presentation, appearing to correspond to different temporal clinical patterns. Surgical repair was the only factor associated with lower in-hospital mortality in the multivariable model (OR\u2009=\u20090.06, 95% CI 0.01\u20130.36,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Absence of emergency PCI, Killip class III\u2013IV, female sex, and hypoalbuminemia were independently associated with CR after AMI. FWR and VSR showed different clinical and hemodynamic patterns. Surgical repair was associated with lower in-hospital mortality among selected CR patients, supporting prompt multidisciplinary evaluation while recognizing the likelihood of survivor and indication bias.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1827832","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T04:29:22Z","timestamp":1781065762000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors, subtype profiles, and outcomes of cardiac rupture after acute myocardial infarction: a case-control study"],"prefix":"10.3389","volume":"13","author":[{"given":"Dan","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory, Wuhan Asia General Hospital, Wuhan Asia General Hospital Affiliated to Wuhan University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaojie","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Wuhan Asia General Hospital, Wuhan Asia General Hospital Affiliated to Wuhan University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaosu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Wuhan Asia General Hospital, Wuhan Asia General Hospital Affiliated to Wuhan University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingdan","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Wuhan Asia General Hospital, Wuhan Asia General Hospital Affiliated to Wuhan University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Litao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Wuhan Asia General Hospital, Wuhan Asia General Hospital Affiliated to Wuhan University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Wuhan Asia General Hospital, Wuhan Asia General Hospital Affiliated to Wuhan University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1001\/jamacardio.2020.3690","article-title":"Mechanical complications of acute myocardial infarction: a review","volume":"6","author":"Gong","year":"2021","journal-title":"JAMA Cardiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1631\/jzus.B1200306","article-title":"Risk of cardiac rupture after acute myocardial infarction is related to a risk of hemorrhage","volume":"14","author":"Qian","year":"2013","journal-title":"J Zhejiang Univ Sci B"},{"key":"B3","doi-asserted-by":"publisher","first-page":"720","DOI":"10.1136\/jim-2018-000841","article-title":"Risk factors for cardiac rupture complicating myocardial infarction: a PRISMA meta-analysis and systematic review","volume":"67","author":"Hao","year":"2019","journal-title":"J Investig Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1401609","DOI":"10.3389\/fcvm.2024.1401609","article-title":"Factors related to cardiac rupture after acute myocardial infarction","volume":"11","author":"Gao","year":"2024","journal-title":"Front Cardiovasc Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1721103","DOI":"10.3389\/fcvm.2026.1721103","article-title":"Risk prediction models for cardiac rupture after acute myocardial infarction: a systematic review and meta-analysis","volume":"13","author":"Mao","year":"2026","journal-title":"Front Cardiovasc Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e618","DOI":"10.1161\/CIR.0000000000000617","article-title":"Fourth universal definition of myocardial infarction","volume":"138","author":"Thygesen","year":"2018","journal-title":"Circulation"},{"key":"B7","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1016\/j.ijcard.2003.06.006","article-title":"Cardiac rupture complicating myocardial infarction","volume":"95","author":"Wehrens","year":"2004","journal-title":"Int J Cardiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e000984","DOI":"10.1161\/JAHA.114.000984","article-title":"Trends in the clinical and pathological characteristics of cardiac rupture in patients with acute myocardial infarction over 35 years","volume":"3","author":"Honda","year":"2014","journal-title":"J Am Heart Assoc"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1256","DOI":"10.21037\/jtd-22-394","article-title":"Risk factors for cardiac rupture after acute ST-segment elevation myocardial infarction during the percutaneous coronary intervention era: a retrospective case-control study","volume":"14","author":"Xu","year":"2022","journal-title":"J Thorac Dis"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1825","DOI":"10.1016\/j.jcin.2019.04.039","article-title":"Temporal trends and outcomes of mechanical complications in patients with acute myocardial infarction","volume":"12","author":"Elbadawi","year":"2019","journal-title":"JACC Cardiovasc Interv"},{"key":"B11","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.amjcard.2009.08.653","article-title":"Mechanical complications after percutaneous coronary intervention in ST-elevation myocardial infarction (from APEX-AMI)","volume":"105","author":"French","year":"2010","journal-title":"Am J Cardiol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur Heart J"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1840","DOI":"10.1001\/jama.2021.18323","article-title":"Cardiogenic shock after acute myocardial infarction: a review","volume":"326","author":"Samsky","year":"2021","journal-title":"JAMA"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e031401","DOI":"10.1161\/JAHA.123.031401","article-title":"Early utilization of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: the National Cardiogenic Shock Initiative","volume":"12","author":"Basir","year":"2023","journal-title":"J Am Heart Assoc"},{"key":"B15","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1016\/j.yjmcc.2007.06.011","article-title":"Differences in inflammation, MMP activation and collagen damage account for gender difference in murine cardiac rupture following myocardial infarction","volume":"43","author":"Fang","year":"2007","journal-title":"J Mol Cell Cardiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s40364-017-0111-x","article-title":"Critical appraisal of the role of serum albumin in cardiovascular disease","volume":"5","author":"Chien","year":"2017","journal-title":"Biomark Res"},{"key":"B17","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1016\/S0272-6386(99)70306-9","article-title":"Effect of increasing serum albumin on plasma D-dimer, von Willebrand factor, and platelet aggregation in CAPD patients","volume":"33","author":"Kim","year":"1999","journal-title":"Am J Kidney Dis"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1702","DOI":"10.1111\/echo.13739","article-title":"Papillary muscle rupture following acute myocardial infarction: anatomic, echocardiographic, and surgical insights","volume":"34","author":"Harari","year":"2017","journal-title":"Echocardiography"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1016\/j.amjcard.2005.01.041","article-title":"Risk factors, echocardiographic patterns, and outcomes in patients with acute ventricular septal rupture during myocardial infarction","volume":"95","author":"Vargas-Barron","year":"2005","journal-title":"Am J Cardiol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e2128309","DOI":"10.1001\/jamanetworkopen.2021.28309","article-title":"Surgical treatment of postinfarction ventricular septal rupture","volume":"4","author":"Ronco","year":"2021","journal-title":"JAMA Netw Open"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1886","DOI":"10.1016\/j.jacc.2024.01.041","article-title":"Ventricular septal rupture after myocardial infarction: JACC Focus Seminar 3\/5","volume":"83","author":"Cubeddu","year":"2024","journal-title":"J Am Coll Cardiol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"177","DOI":"10.21037\/cdt-21-577","article-title":"Outcomes of surgical repair of anterior or posterior ventricular septal rupture after myocardial infarction","volume":"12","author":"Fu","year":"2022","journal-title":"Cardiovasc Diagn Ther"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1348981","DOI":"10.3389\/fcvm.2023.1348981","article-title":"Surgical repair of left ventricular free-wall rupture complicating acute myocardial infarction: a single-center 30 years of experience","volume":"10","author":"Matteucci","year":"2024","journal-title":"Front Cardiovasc Med"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e238213","DOI":"10.14503\/THIJ-23-8213","article-title":"Surgical outcome of postinfarction left ventricular free wall rupture","volume":"51","author":"Na","year":"2024","journal-title":"Tex Heart Inst J"},{"key":"B25","doi-asserted-by":"publisher","first-page":"239","DOI":"10.21037\/acs-2021-ami-20","article-title":"Surgical management for mechanical complications of acute myocardial infarction: a systematic review of long-term outcomes","volume":"11","author":"Yousef","year":"2022","journal-title":"Ann Cardiothorac Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e16","DOI":"10.1161\/CIR.0000000000000985","article-title":"Mechanical complications of acute myocardial infarction: a scientific statement from the American Heart Association","volume":"144","author":"Damluji","year":"2021","journal-title":"Circulation"},{"key":"B27","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1016\/j.ccl.2013.07.004","article-title":"Mechanical complications of acute myocardial infarction","volume":"31","author":"Kutty","year":"2013","journal-title":"Cardiol Clin"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1827832\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T04:29:24Z","timestamp":1781065764000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1827832\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,10]]},"references-count":27,"alternative-id":["10.3389\/fcvm.2026.1827832"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1827832","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,10]]},"article-number":"1827832"}}