ECG changes may signal cardiac rupture after STEMI, study finds

Cardiac rupture is one of the most feared complications of ST-segment elevation myocardial infarction (STEMI), and catching it early can mean the difference between life and death. A new retrospective multicenter cohort study, published in the European Journal of Medical Research, reports that a distinctive pattern of electrocardiographic changes may help clinicians recognize this catastrophic complication before it is too late.

The study drew on records from four hospitals over a 17-year period and focused on 30 patients diagnosed with cardiac rupture after STEMI. Electrocardiograms were obtained at emergency department presentation, performed daily during hospitalization, and repeated as clinically indicated. The researchers analyzed the dynamic ECG evolution that followed initial ST-segment resolution, looking specifically at new-onset or recurrent ST-segment elevation and dynamic ST-segment depression in lead AVR, alongside clinical presentation and imaging findings.

The results point to a consistent signature. Of the 30 patients, 26 (87%) developed new-onset ST-segment elevation, an equal proportion showed recurrent elevation, and 17 (57%) exhibited dynamic ST-segment depression in lead AVR. Overall, 26 patients (87%) displayed at least two of these features, and 13 (43%) demonstrated the full ECG pattern.

The researchers also quantified how the ECG changed as rupture approached. The median number of leads showing ST-segment elevation fell from 6 at baseline to 4 before rupture, and the median total magnitude of elevation declined from 8 to 4 mm. Compared with the pre-rupture phase, however, the median number of involved leads rose to 8 and total ST-segment elevation to 13.5 mm at the time of rupture, indicating more diffuse and pronounced abnormalities.

In exploratory analyses, anterior infarction was associated with a greater extent of ST-segment elevation at baseline, reflected by more elevated leads and greater total elevation, but not at the time of cardiac rupture. The authors caution that these analyses were exploratory in nature.

Based on these findings, the study concludes that cardiac rupture following STEMI is characterized by a distinctive ECG evolution: new-onset or recurrent ST-segment elevation occurring together with depression in lead AVR. The authors suggest that recognition of these features should prompt echocardiographic evaluation to enable early diagnosis and timely intervention.

The study’s retrospective design and small sample of 30 patients mean the findings should be interpreted with care, and the authors describe the ECG pattern as a signal that warrants confirmatory imaging rather than a stand-alone diagnostic test. Even so, the work addresses a long-standing gap: as the authors note in the abstract, electrocardiographic evidence for the early diagnosis of cardiac rupture has remained limited, despite the potential for early recognition to be lifesaving and to reduce mortality.

Subject of Research: Electrocardiographic patterns associated with early recognition of cardiac rupture after STEMI

Article Title: ECG patterns for early recognition of cardiac rupture in STEMI

Article References: Yang, H., Lei, X., Song, Y., Zhao, Z., Tong, L., Wang, Z., Wu, H., Chen, J., Wang, Q., Gao, J., Zhang, Y., Cao, J., Zhang, F., Qian, J., Huang, Z., & Ge, J. (2026). ECG patterns for early recognition of cardiac rupture in STEMI. European Journal of Medical Research. https://doi.org/10.1186/s40001-026-05400-x

Image Credits: AI Generated

DOI: 10.1186/s40001-026-05400-x

Keywords: STEMI, cardiac rupture, ECG, ST-segment elevation, lead AVR, echocardiography, myocardial infarction, electrocardiography, retrospective cohort study, early diagnosis, patterns, early