Mechanical complications in patients with ST-segment elevation myocardial infarction: A single centre experience.

Lanz, Jonas; Wyss, Dörte; Räber, Lorenz; Stortecky, Stefan; Hunziker, Lukas; Blöchlinger, Stefan; Reineke, David; Englberger, Lars; Zanchin, Thomas; Valgimigli, Marco; Heg, Dik; Windecker, Stephan; Pilgrim, Thomas (2019). Mechanical complications in patients with ST-segment elevation myocardial infarction: A single centre experience. PLoS ONE, 14(2), e0209502. Public Library of Science 10.1371/journal.pone.0209502

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BACKGROUND The study aims to assess characteristics and outcomes of patients suffering a mechanical complication (MC) after ST-segment elevation myocardial infarction (STEMI) in a contemporary cohort of patients in the percutaneous coronary intervention era. METHODS AND RESULTS This retrospective single-center cohort study encompasses 2508 patients admitted with STEMI between March 9, 2009 and June 30, 2014. A total of 26 patients (1.1%) suffered a mechanical complication: ventricular septal rupture (VSR) in 17, ventricular free wall rupture (VFWR) in 2, a combination of VSD and VFWR in 2, and papillary muscle rupture (PMR) in 5 patients. Older age (74.5 ± 10.4 years versus 63.9 ± 13.1 years, p < 0.001), female sex (42.3% versus 23.3%, p = 0.034), and a longer latency period between symptom onset and angiography (> 24h: 42.3% versus 16.2%, p = 0.002) were more frequent among patients with MC as compared to patients without MC. The majority of MC patients had multivessel disease (77%) and presented in cardiogenic shock (Killip class IV: 73.1%). Nine patients (7 VSR, 2 VFWR & VSR) were treated conservatively and died. Out of the remaining 10 VSR patients, four underwent surgery, three underwent implantation of an occluder device, and another three patients had surgical repair following occluder device implantation. All patients with isolated VFWR and PMR underwent emergency surgery. At 30 days, mortality for VSR, VFWR, VFWR & VSR and PMR amounted to 71%, 50%, 100% and 0%, respectively. CONCLUSIONS Despite advances in the management of STEMI patients, mortality of mechanical complications stays considerable in this contemporary cohort. Older age, female sex, and a prolonged latency period between symptom onset and angiography are associated with the occurrence of these complications.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Lanz, Jonas; Wyss, Dörte; Räber, Lorenz; Stortecky, Stefan; Hunziker, Lukas; Blöchlinger, Stefan; Reineke, David Christian; Englberger, Lars; Zanchin, Thomas; Valgimigli, Marco; Heg, Dierik Hans; Windecker, Stephan and Pilgrim, Thomas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1932-6203

Publisher:

Public Library of Science

Language:

English

Submitter:

Beatrice Minder Wyssmann

Date Deposited:

04 Mar 2019 11:10

Last Modified:

06 Mar 2019 11:09

Publisher DOI:

10.1371/journal.pone.0209502

Related URLs:

PubMed ID:

30794547

BORIS DOI:

10.7892/boris.127355

URI:

https://boris.unibe.ch/id/eprint/127355

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