Risk factors, subtype profiles, and outcomes of cardiac rupture after acute myocardial infarction: a case-control study.

Background: 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. Methods: 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-December 2025). Factors independently associated with CR were identified using multivariable logistic regression with the events-per-variable principle (≥10). Model discrimination was assessed by the C-statistic and calibration by the Hosmer-Lemeshow test. Subtype comparisons (FWR vs. VSR), early (≤3 days) vs. late (>3 days) rupture analysis, and in-hospital mortality correlates were also evaluated. Results: Patients with CR were older (69.6 ± 8.5 vs. 59.5 ± 11.7 years, Conclusions: Absence of emergency PCI, Killip class III-IV, 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.