open access

Vol 28, No 4 (2021)
Original Article
Published online: 2020-12-17
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In-hospital outcomes of mechanical complications in acute myocardial infarction: Analysis from a nationwide Spanish database

Marcelo Sanmartín-Fernández, Sergio Raposeiras-Roubin, Manuel Anguita-Sánchez, Francisco Marín, María Garcia-Marquez, Cristina Fernández-Pérez, Jose-Luis Bernal-Sobrino, Francisco Javier Elola-Somoza, Héctor Bueno, Ángel Cequier
DOI: 10.5603/CJ.a2020.0181
·
Pubmed: 33346367
·
Cardiol J 2021;28(4):589-597.

open access

Vol 28, No 4 (2021)
Original articles — Clinical cardiology
Published online: 2020-12-17

Abstract

Background: Mechanical complications represent an important cause of mortality in myocardial infarction (MI) patients. This is a nationwide study performed to evaluate possible changes in epidemiology or prognosis of these complications with current available strategies.
Methods: Information was obtained from the minimum basis data set of the Spanish National Health System, including all hospitalizations for acute myocardial infarction (AMI) from 2010 to 2015. Risk-standardized in-hospital mortality ratio was calculated using multilevel risk adjustment models.
Results: A total of 241,760 AMI episodes were analyzed, MI mechanical complications were observed in 842 patients: cardiac tamponade in 587, ventricular septal rupture in 126, and mitral regurgitation due to papillary muscle or chordae tendineae rupture in 155 (there was more than one complication in 21 patients). In-hospital mortality was 59.5%. On multivariate adjustment, variables with significant impact on in-hospital mortality were: age (OR 1.06; 95% CI 1.04–1.07; p < 0.001), ST-segment elevation AMI (OR 2.91; 95% CI 1.88–4.5; p < 0.001), cardiogenic shock (OR 2.35; 95% CI 1.66–3.32; p < 0.001), cardio-respiratory failure (OR 3.48; 95% CI 2.37–5.09; p < 0.001), and chronic obstructive pulmonary disease (OR 1.85; 95% CI 1.07–3.20; p < 0.001). No significant trends in risk-adjusted in-hospital mortality were detected (IRR 0.997; p = 0.109). Cardiac intensive care unit availability and more experience with mechanical complications management were associated with lower adjusted mortality rates (56.7 ± 5.8 vs. 60.1 ± 4.5; and 57 ± 6.1 vs. 59.9 ± 5.6, respectively; p < 0.001).
Conclusions: Mechanical complications occur in 3.5 per thousand AMI, with no significant trends to better survival over the past few years. Advanced age, cardiogenic shock and cardio-respiratory failure are the most important risk factors for in-hospital mortality. Higher experience and specialized cardiac intensive care units are associated with better outcomes.

Abstract

Background: Mechanical complications represent an important cause of mortality in myocardial infarction (MI) patients. This is a nationwide study performed to evaluate possible changes in epidemiology or prognosis of these complications with current available strategies.
Methods: Information was obtained from the minimum basis data set of the Spanish National Health System, including all hospitalizations for acute myocardial infarction (AMI) from 2010 to 2015. Risk-standardized in-hospital mortality ratio was calculated using multilevel risk adjustment models.
Results: A total of 241,760 AMI episodes were analyzed, MI mechanical complications were observed in 842 patients: cardiac tamponade in 587, ventricular septal rupture in 126, and mitral regurgitation due to papillary muscle or chordae tendineae rupture in 155 (there was more than one complication in 21 patients). In-hospital mortality was 59.5%. On multivariate adjustment, variables with significant impact on in-hospital mortality were: age (OR 1.06; 95% CI 1.04–1.07; p < 0.001), ST-segment elevation AMI (OR 2.91; 95% CI 1.88–4.5; p < 0.001), cardiogenic shock (OR 2.35; 95% CI 1.66–3.32; p < 0.001), cardio-respiratory failure (OR 3.48; 95% CI 2.37–5.09; p < 0.001), and chronic obstructive pulmonary disease (OR 1.85; 95% CI 1.07–3.20; p < 0.001). No significant trends in risk-adjusted in-hospital mortality were detected (IRR 0.997; p = 0.109). Cardiac intensive care unit availability and more experience with mechanical complications management were associated with lower adjusted mortality rates (56.7 ± 5.8 vs. 60.1 ± 4.5; and 57 ± 6.1 vs. 59.9 ± 5.6, respectively; p < 0.001).
Conclusions: Mechanical complications occur in 3.5 per thousand AMI, with no significant trends to better survival over the past few years. Advanced age, cardiogenic shock and cardio-respiratory failure are the most important risk factors for in-hospital mortality. Higher experience and specialized cardiac intensive care units are associated with better outcomes.

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Keywords

myocardial infarction, mechanical complications, ventricular septal rupture, papillary muscle rupture, cardiac tamponade

Supp./Additional Files (3)
Suppl. Figure 1. Temporal trends in cardiac interventions for patients with mechanical complications secondary to acute myocardial infarction (AMI) and patients with and without mechanical complications (MC). PCI = percutaneous coronary intervention; CABG
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Suppl. Figure 2. Crude (CMR) and risk-standardized in-hospital mortality ratio (RSMR) of patients with acute myocardial infarctions (AMI) with and without mechanical complications (MC) between 2010 and 2015.
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About this article
Title

In-hospital outcomes of mechanical complications in acute myocardial infarction: Analysis from a nationwide Spanish database

Journal

Cardiology Journal

Issue

Vol 28, No 4 (2021)

Article type

Original Article

Pages

589-597

Published online

2020-12-17

DOI

10.5603/CJ.a2020.0181

Pubmed

33346367

Bibliographic record

Cardiol J 2021;28(4):589-597.

Keywords

myocardial infarction
mechanical complications
ventricular septal rupture
papillary muscle rupture
cardiac tamponade

Authors

Marcelo Sanmartín-Fernández
Sergio Raposeiras-Roubin
Manuel Anguita-Sánchez
Francisco Marín
María Garcia-Marquez
Cristina Fernández-Pérez
Jose-Luis Bernal-Sobrino
Francisco Javier Elola-Somoza
Héctor Bueno
Ángel Cequier

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