Abstract
BackgroundThe study aims to assess characteristics and outcomes of patients suffering a mechanical complication (MC) after ST-segment elevation myocardial infarction (STEMI) in a contemporary cohort of patients in the percutaneous coronary intervention era.Methods and resultsThis retrospective single-center cohort study encompasses 2508 patients admitted with STEMI between March 9, 2009 and June 30, 2014. A total of 26 patients (1.1%) suffered a mechanical complication: ventricular septal rupture (VSR) in 17, ventricular free wall rupture (VFWR) in 2, a combination of VSD and VFWR in 2, and papillary muscle rupture (PMR) in 5 patients. Older age (74.5 ± 10.4 years versus 63.9 ± 13.1 years, p < 0.001), female sex (42.3% versus 23.3%, p = 0.034), and a longer latency period between symptom onset and angiography (> 24h: 42.3% versus 16.2%, p = 0.002) were more frequent among patients with MC as compared to patients without MC. The majority of MC patients had multivessel disease (77%) and presented in cardiogenic shock (Killip class IV: 73.1%). Nine patients (7 VSR, 2 VFWR & VSR) were treated conservatively and died. Out of the remaining 10 VSR patients, four underwent surgery, three underwent implantation of an occluder device, and another three patients had surgical repair following occluder device implantation. All patients with isolated VFWR and PMR underwent emergency surgery. At 30 days, mortality for VSR, VFWR, VFWR & VSR and PMR amounted to 71%, 50%, 100% and 0%, respectively.ConclusionsDespite advances in the management of STEMI patients, mortality of mechanical complications stays considerable in this contemporary cohort. Older age, female sex, and a prolonged latency period between symptom onset and angiography are associated with the occurrence of these complications.
Highlights
Papillary muscle rupture, ventricular septal rupture and free wall rupture complicating myocardial infarction are rare but devastating sequelae of myocardial necrosis
At 30 days, mortality for ventricular septal rupture (VSR), ventricular free wall rupture (VFWR), VFWR & VSR and papillary muscle rupture (PMR) amounted to 71%, 50%, 100% and 0%, respectively
Despite advances in the management of ST-elevation myocardial infarction (STEMI) patients, mortality of mechanical complications stays considerable in this contemporary cohort
Summary
Ventricular septal rupture and free wall rupture complicating myocardial infarction are rare but devastating sequelae of myocardial necrosis. The incidence of mechanical complications has decreased owing to the development of reperfusion and adjunct medical therapies, these adverse events still go along with an exceptionally high mortality rate and constitute one of the major causes of death in the early phase after myocardial infarction. Most available data describing the frequency and characteristics of mechanical complications stem from the early reperfusion era evaluating fibrinolytic therapy. [1,2,3,4] The objective of the present study is to assess characteristics and outcomes of patients with a mechanical complication (MC) after ST-elevation myocardial infarction (STEMI) in a contemporary cohort of consecutive patients in the era of primary percutaneous coronary intervention. The study aims to assess characteristics and outcomes of patients suffering a mechanical complication (MC) after ST-segment elevation myocardial infarction (STEMI) in a contemporary cohort of patients in the percutaneous coronary intervention era
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