A multicenter study on the clinical characteristics and risk factors of in-hospital mortality in patients with mechanical complications following acute ... View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2020-04-01

AUTHORS

Yorihiko Koeda, Tomonori Itoh, Yu Ishikawa, Yoshihiro Morino, Tomohiro Mizutani, Junya Ako, Masataka Nakano, Koichiro Yoshioka, Yuji Ikari, Shu Inami, Masashi Sakuma, Isao Taguchi, Tetsuya Ishikawa, Hiroyuki Sugimura, Keiki Sugi, Kazuo Matsumoto, Takanobu Mitarai, Tomoyuki Kunishima, Yoshihiro J. Akashi, Takahiro Nomura, Kei Fukushi, Hideaki Yoshino

ABSTRACT

Mechanical complications (MCs) following acute myocardial infarction (AMI), such as ventricular septal rupture (VSR), free-wall rupture (FWR), and papillary muscle rupture (PMR), are fatal. However, the risk factors of in-hospital mortality among patients with MCs have not been previously reported in Japan. The purpose of this study was to evaluate the prognostic factors of in-hospital mortality in these patients. The study cohort consisted of 233 consecutive patients with MCs from the registry of 10 facilities in the Cardiovascular Research Consortium-8 Universities (CIRC-8U) in East Japan between 1997 and 2014 (2.3% of 10,278 AMI patients). The authors conducted a retrospective observational study to analyse the correlation between the subtypes of MCs with in-hospital mortality, clinical data, and medical treatment. We observed a decreasing incidence of MC (1997–2004: 3.7%, 2005–2010: 2.1%, 2011–2014: 1.9%, p < 0.001). In-hospital mortality among patients with MCs was 46%. Thirty-three percent of patients with MCs were not able to undergo surgical repair due to advanced age or severe cardiogenic shock. In-hospital mortality among patients who had undergone surgical repair was 29% (VSR: 21%, FWR: 33%, PMR: 60%). In patients with MCs, hazard ratio for in-hospital mortality according to multivariate analysis of without surgical repair was 5.63 (95% CI 3.54–8.95). In patients with surgical repair, the hazard ratios of blow-out-type FWR (5.53, 95% confidence interval (CI) 2.22–13.76), those with renal dysfunction (3.11, 95% CI 1.37–7.05), and those receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) (3.79, 95% CI 1.81–7.96) were significantly high. Although primary percutaneous coronary intervention (PCI) is associated with decreased incidence of MCs, high in-hospital mortality persisted in patients with MCs that also presented with renal dysfunction and in those requiring VA-ECMO. Early detection and surgical repair of MCs are essential. More... »

PAGES

1060-1069

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00380-020-01586-0

DOI

http://dx.doi.org/10.1007/s00380-020-01586-0

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1126046972

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/32239276


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    "description": "Mechanical complications (MCs) following acute myocardial infarction (AMI), such as ventricular septal rupture (VSR), free-wall rupture (FWR), and papillary muscle rupture (PMR), are fatal. However, the risk factors of in-hospital mortality among patients with MCs have not been previously reported in Japan. The purpose of this study was to evaluate the prognostic factors of in-hospital mortality in these patients. The study cohort consisted of 233 consecutive patients with MCs from the registry of 10 facilities in the Cardiovascular Research Consortium-8 Universities (CIRC-8U) in East Japan between 1997 and 2014 (2.3% of 10,278 AMI patients). The authors conducted a retrospective observational study to analyse the correlation between the subtypes of MCs with in-hospital mortality, clinical data, and medical treatment. We observed a decreasing incidence of MC (1997\u20132004: 3.7%, 2005\u20132010: 2.1%, 2011\u20132014: 1.9%, p\u2009<\u20090.001). In-hospital mortality among patients with MCs was 46%. Thirty-three percent of patients with MCs were not able to undergo surgical repair due to advanced age or severe cardiogenic shock. In-hospital mortality among patients who had undergone surgical repair was 29% (VSR: 21%, FWR: 33%, PMR: 60%). In patients with MCs, hazard ratio for in-hospital mortality according to multivariate analysis of without surgical repair was 5.63 (95% CI 3.54\u20138.95). In patients with surgical repair, the hazard ratios of blow-out-type FWR (5.53, 95% confidence interval (CI) 2.22\u201313.76), those with renal dysfunction (3.11, 95% CI 1.37\u20137.05), and those receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) (3.79, 95% CI 1.81\u20137.96) were significantly high. Although primary percutaneous coronary intervention (PCI) is associated with decreased incidence of MCs, high in-hospital mortality persisted in patients with MCs that also presented with renal dysfunction and in those requiring VA-ECMO. Early detection and surgical repair of MCs are essential.", 
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