Cardiac Rupture Complicating Acute and Subacute Myocardial Infarction at Forensic Autopsy

With the advent of percutaneous coronary reperfusion, the incidence of cardiac rupture in the setting of myocardial infarction has decreased substantially. Yet cardiac rupture remains a widely feared complication due to its rapid onset and limited therapeutic options. The early identification of individuals most at risk for rupture, as well as modifiable risk factors that contribute to delays in therapy, is crucial for improving outcomes associated with this disease. A retrospective review of autopsies performed between 2010 and 2024 at the Cuyahoga Office of Chief Medical Examiner revealed 288 cases of myocardial infarction, of which 63 (22%) were complicated by cardiac rupture. Decedents with cardiac rupture were more likely to be White and older than decedents without rupture. When compared with age, race, and sex-matched controls, decedents with rupture were less likely to demonstrate cardiomegaly and myocardial fibrosis at autopsy and to have a documented history of diabetes mellitus. There was no difference in the receipt of cardiopulmonary resuscitation between the groups. The study group demonstrated a much higher rate of cardiac rupture and a longer duration of preceding symptoms than has been previously reported in clinical studies.