Current Mechanical Complications of Infarction

Contemporary data of a recently published large registry show that mechanical complications after infarction are not frequent but maintain a very high mortality rate that does not seem to improve over time.

Our information on mechanical complications was outdated and we did not have current data on their incidence and prognosis. Such is precisely the aim of this work recently published in J Am Coll Cardiol Intv 2019: to bring us up to speed on mechanical complications in both ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction.

Patients registered in a nationwide database from 2003 to 2015 were analyzed to identify all subjects admitted with (ST-segment elevation and non-ST-segment elevation) myocardial infarction who then experienced papillary muscle rupture, ventricular septal defect, and free wall rupture.

The analysis included astonishing numbers: 3,951,861 patients with ST-segment elevation myocardial infarction and 5,114,270 patients with non-ST-segment elevation myocardial infarction.

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The rate of mechanical complications was 0.27% in ST-segment elevation myocardial infarction and 0.06% in non-ST-segment elevation myocardial infarction.

The incidence did not change over the years. Mortality was 42.4% for patients with ST-segment elevation myocardial infarction and 18% for patients with non-ST-segment elevation myocardial infarction. There were no changes over time in that trend either.

Mechanical complications came along other complications such as cardiogenic shock, acute kidney injury, hemodialysis, and respiratory complications.

Predictors of better prognosis in patients with mechanical complications who developed cardiogenic shock included surgical repair (in both cohorts) and angioplasty in the ST-segment elevation myocardial infarction cohort.

Conclusion

Contemporary data from a large patient registry show that the rates of mechanical complications after infarction are very low, but mortality is extremely high in such cases. Time did not lower their incidence and associated mortality.

Original Title: Temporal Trends and Outcomes of Mechanical Complications in Patients With Acute Myocardial Infarction.

Reference: Ayman Elbadawi et al. J Am Coll Cardiol Intv 2019;12:1825–36.

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