Temporal Trends and Outcomes of Mechanical Complications in Patients With Acute Myocardial Infarction

Ayman Elbadawi, Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas; Division of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt.
Islam Y. Elgendy, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
Karim Mahmoud, Department of Internal Medicine, Houston Medical Center, Warner Robbins, Georgia.
Amr F. Barakat, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Amgad Mentias, Division of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa.
Ahmed H. Mohamed, Rochester Regional HealthFollow
Gbolahan O. Ogunbayo, Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky.
Michael Megaly, Department of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota; Department of Cardiology, Hennepin Healthcare, Minneapolis, Minnesota.
Marwan Saad, Division of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt; Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Mohamed A. Omer, Department of Cardiovascular Medicine, University of Missouri Kansas City, Kansas City, Missouri.
David Paniagua, Division of Cardiology, Baylor School of Medicine and the Michael E DeBakey VAMC, Houston, Texas.
J Dawn Abbott, Division of Cardiovascular Medicine, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.
Hani Jneid, Division of Cardiology, Baylor School of Medicine and the Michael E DeBakey VAMC, Houston, Texas.

Department

Internal Medicine

Document Type

Article

Publication Title

Jacc. Cardiovascular Interventions

Abstract

OBJECTIVES: The aim of this study was to examine the temporal trends and outcomes of mechanical complications after myocardial infarction in the contemporary era. BACKGROUND: Data regarding temporal trends and outcomes of mechanical complications after ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) are limited in the contemporary era. METHODS: The National Inpatient Sample database (2003 to September 2015) was queried to identify all STEMI and NSTEMI hospitalizations. Temporal trends and outcomes of mechanical complications after STEMI and NSTEMI, including papillary muscle rupture, ventricular septal defect, and free wall rupture, were described. RESULTS: The analysis included 3,951,861 STEMI and 5,114,270 NSTEMI hospitalizations. Mechanical complications occurred in 10,726 of STEMI hospitalizations (0.27%) and 3,041 of NSTEMI hospitalizations (0.06%), with no changes in trends (p = 0.13 and p = 0.83, respectively). The rates of in-hospital mortality in patients with mechanical complications were 42.4% after STEMI and 18.0% after NSTEMI, with no significant trend changes (p = 0.62 and p = 0.12, respectively). After multivariate adjustment, patients who had mechanical complications after myocardial infarction had higher in-hospital mortality, cardiogenic shock, acute kidney injury, hemodialysis, and respiratory complications compared with those without mechanical complications. Predictors of lower mortality in patients with mechanical complications who developed cardiogenic shock included surgical repair in the STEMI and NSTEMI cohorts and percutaneous coronary intervention in the STEMI cohort. CONCLUSIONS: Contemporary data from a large national database show that the rates of mechanical complications are low in patients presenting with STEMI and NSTEMI. Post-myocardial infarction mechanical complications continue to be associated with high mortality rates, which did not improve during the study period.

First Page

1825

Last Page

1836

DOI

10.1016/j.jcin.2019.04.039

Volume

12

Issue

18

Publication Date

9-23-2019

Medical Subject Headings

Aged; Aged, 80 and over; Databases, Factual; Female; Heart Rupture, Post-Infarction (diagnostic imaging, epidemiology, mortality); Hospital Mortality (trends); Humans; Inpatients; Male; Middle Aged; Non-ST Elevated Myocardial Infarction (diagnostic imaging, epidemiology, mortality, therapy); Prognosis; Risk Assessment; Risk Factors; ST Elevation Myocardial Infarction (diagnostic imaging, epidemiology, mortality, therapy); Time Factors; United States (epidemiology); Ventricular Septal Rupture (diagnostic imaging, epidemiology, mortality)

PubMed ID

31537282

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