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Ouaddi NE, de Diego O, Labata C, Rueda F, Martínez MJ, Cámara ML, Berastegui E, Oliveras T, Ferrer M, Montero S, Serra J, Muñoz-Guijosa C, Lupón J, Bayés-Genis A, García-García C. Mechanical complications in STEMI: prevalence and mortality trends in the primary PCI era. The Ruti-STEMI registry. Rev Esp Cardiol (Engl Ed) 2023; 76:427-433. [PMID: 36228958 DOI: 10.1016/j.rec.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/22/2022] [Indexed: 05/28/2023]
Abstract
INTRODUCTION AND OBJECTIVES Mechanical complications confer a dreadful prognosis in ST-elevation myocardial infarction (STEMI). Their prevalence and prognosis are not well-defined in the current era of primary percutaneous coronary intervention (pPCI) reperfusion networks. We aimed to analyze prevalence and mortality trends of post-STEMI mechanical complications over 2 decades, before and after the establishment of pPCI networks. METHODS Prospective, consecutive registry of STEMI patients within a region of 850 000 inhabitants over 2 decades: a pre-pPCI period (1990-2000) and a pPCI period (2007-2017). We analyzed the prevalence of mechanical complications, including ventricular septal rupture, papillary muscle rupture, and free wall rupture (FWR). Twenty eight-day and 1-year mortality trends were compared between the 2 studied decades. RESULTS A total of 6033 STEMI patients were included (pre-pPCI period, n=2250; pPCI period, n=3783). Reperfusion was supported by thrombolysis in the pre-pPCI period (99.1%) and by pPCI in in the pPCI period (95.7%). Mechanical complications developed in 135 patients (2.2%): ventricular septal rupture in 38 patients, papillary muscle rupture in 24, and FWR in 73 patients. FWR showed a relative reduction of 60% in the pPCI period (0.8% vs 2.0%, P<.001), without significant interperiod changes in the other mechanical complications. After multivariate adjustment, FWR remained higher in the pre-pPCI period (OR, 1.93; 95%CI, 1.10-3.41; P=.023). At 28 days and 1 year, mortality showed no significant changes in all the mechanical complications studied. CONCLUSIONS The establishment of regional pPCI networks has modified the landscape of mechanical complications in STEMI. FWR is less frequent in the pPCI era, likely due to reduced transmural infarcts.
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Affiliation(s)
- Nabil El Ouaddi
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Oriol de Diego
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Servicio de Cardiología, Hospital Clínic i Provincial, Barcelona, España; PhD program, Department of Medicine Autonomous University of Barcelona, Barcelona, España
| | - Carlos Labata
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ferran Rueda
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - María José Martínez
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - María Luisa Cámara
- Cirugía Cardiaca, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elisabet Berastegui
- Cirugía Cardiaca, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Teresa Oliveras
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Marc Ferrer
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Santiago Montero
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jordi Serra
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Christian Muñoz-Guijosa
- Cirugía Cardiaca, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep Lupón
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Antoni Bayés-Genis
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Cosme García-García
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Sánchez-Luna JP, Amat-Santos IJ. Interventional management of mechanical complications in acute myocardial infarction. Rev Esp Cardiol (Engl Ed) 2023; 76:362-369. [PMID: 36813110 DOI: 10.1016/j.rec.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/23/2022] [Indexed: 04/29/2023]
Abstract
Mechanical complications following a myocardial infarction are uncommon, but with dramatic consequences and high mortality. The left ventricle is the most often affected cardiac chamber and complications can be classified according to the timing in early (from days to first weeks) or late complications (from weeks to years). Despite the decrease in the incidence of these complications thank to primary percutaneous coronary intervention programs -wherever this option is available-, the mortality is still significant and these infrequent complications are an emergent scenario and one of the most important causes of mortality at short term in patients with myocardial infarction. Mechanical circulatory support devices, especially if minimally invasive implantation is used avoiding thoracotomy, have improved the prognosis of these patients by providing stability until definitive treatment can be applied. On the other hand, the growing experience in transcatheter interventions for the treatment of ventricular septal rupture or acute mitral regurgitation has been associated to an improvement in their results, even though prospective clinical evidence is still missing.
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Affiliation(s)
- Juan Pablo Sánchez-Luna
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Ignacio J Amat-Santos
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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Sánchez Vega JD, Alonso Salinas GL, Viéitez Flórez JM, Ariza Solé A, López de Sá E, Sanz Ruiz R, Burgos Palacios V, Raposeiras-Roubín S, Gómez Varela S, Sanchis J, Silva Melchor L, Martínez-Seara X, Malagón López L, Zamorano Gómez JL, Sanmartín Fernández M; CIVIAM Study Investigators. Temporal trends in postinfarction ventricular septal rupture: the CIVIAM Registry. ACTA ACUST UNITED AC 2021; 74:757-64. [PMID: 32883644 DOI: 10.1016/j.rec.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Postinfarction ventricular septal rupture is a rare but severe complication of myocardial infarction with high mortality rates. Our goal was to analyze which factors could have an impact on mortality due to this entity over the past decade, including those related to mechanical circulatory support. METHODS The CIVIAM registry is an observational, retrospective, multicenter study carried out in Spain. We designed a comparative analysis, focused on description of in-hospital management and in-hospital and 1-year total mortality as the primary endpoints, dividing the total observation time into 2 equal temporal periods (January 2008 to June2013 and July 2013 to December 2018). RESULTS We included 120 consecutive patients. Total mortality during this period was 61.7% at 1-year follow-up. Patients in the second period were younger. One-year mortality was significantly reduced in the second period (75.6% vs 52.7%, P=.01), and this result was confirmed after adjustment by confounding factors (OR, 0.40; 95%CI, 0.17-0.98). Surgical repair was attempted in 58.7% vs 70.3%, (P=.194), and percutaneous closure in 8.7% and 6.8%, respectively (P=.476). Heart transplant was performed in 1 vs 5 patients (2.2% vs 6.8%, P=.405). The main difference in the clinical management between the 2 periods was the greater use of venoarterial extracorporeal membrane oxygenatiom in the second half of the study period (4.4% vs 27%; P=.001). CONCLUSIONS Postinfarction ventricular septal rupture still carries a very high mortality risk. There has been a progressive trend to increased support with venoarterial extracorporeal membrane oxygenatiom and greater access to available corrective treatments, with higher survival rates.
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