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February 24, 1999

Cardiac Rupture After Myocardial Infarction—Reply

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(8):703. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-8-jbk0224

In Reply: We appreciate Dr Cheng's observation on the possibility that cardiac rupture may have been in part responsible for the differences in 6-month prognosis between men and women found in the RESCATE (Resources Used in Acute Coronary Syndrome and Delays in Treatment) study. Although our study originally was not designed with the purpose of addressing such a possibility, it showed that women died later over the 6 months after onset of MI symptoms: median time to death was 4 days in men and 5.5 days in women (P< .01) in fatal cases. Thus, cardiac rupture probably does not represent a major reason for women's excess risk of death, since cardiac rupture generally occurs early after onset of symptoms. To assess whether fatal cases were definitely due to cardiac rupture, routine autopsy would be necessary. This was far beyond the scope of our study.