Key result
Mechanical complications post-MI linked to ~20-fold higher 30-day mortality.
Why the study?
The study sought to examine the incidence, characteristics, and treatment of serious myocardial infarction-associated mechanical complications in Japanese patients in the PCI era, focusing on frailty, nutrition, and surgical implications.
Does surgical treatment reduce 30-day mortality compared to conservative treatment in patients with MI-associated mechanical complications?
Observational (n=883)
No
Does surgical treatment reduce 30-day mortality compared to conservative treatment in patients with MI-associated mechanical complications?
Surgical intervention for MI-associated mechanical complications is associated with improved 30-day survival compared to conservative management, despite high baseline surgical risk.
Post-MI mechanical complications markedly raise 30-day mortality; observational data leave open whether surgery improves survival versus conservative care.
In this retrospective observational study, we have examined the incidence, characteristics, and treatment of serious myocardial infarction (MI) -associated mechanical complications (MCs) occurring in Japanese patients in this era of percutaneous coronary intervention (PCI), focusing on frailty, nutrition, and clinical implication of surgery. Included were 883 patients who, having suffered an MI, had been admitted to Nihon University Hospital between January 2013 and April 2020. Fifteen (1.70%) of these patients had suffered a potentially catastrophic MC-ventricular free wall rupture (VFWR, n = 8), ventricular septal rupture (VSR, n = 6), or papillary muscle rupture (PMR, n = 1). Factors associated with the MCs were age, poor nutritional status, a high Killip class, delayed diagnosis of MI, a high lactate concentration, a low thrombolysis in myocardial infarction flow grade, and single-vessel disease. Thirty-day mortality among MC patients was 60% (9/15): 87.5% associated with VFWR, 33.3% associated with VSR and 0% associated with PMR. On adjusted multivariate analysis, occurrence of an MC was independently associated with 30-day mortality. Despite a high surgical risk (EuroSCORE II: 11.8 ± 4.7) with less frailty, 30-day mortality was lower among patients whose MC was treated surgically than among those whose MC was treated conservatively (40.0% versus 100.0%, respectively; P = 0.044).
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Arai et al. (2021) conducted an observational in Myocardial Infarction (n=883). Mechanical complication vs. No mechanical complication was evaluated on 30-day mortality (OR 19.53, 95% CI 6.71-56.79, p=<0.001). Mechanical complications following myocardial infarction were independently associated with a significantly higher 30-day mortality compared to patients without mechanical complications (OR 19.53).
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