Surgical treatment for post-infarction papillary muscle rupture carried a 24.8% in-hospital mortality rate, though concomitant coronary artery bypass grafting improved early survival (OR 0.38; 95% CI 0.16-0.92).
Observational (n=214)
Yes
Does concomitant coronary artery bypass grafting improve early survival in patients undergoing surgery for post-infarction papillary muscle rupture?
Surgical treatment for post-infarction papillary muscle rupture carries a high in-hospital mortality of 24.8%, but performing concomitant CABG when possible may confer a survival benefit.
OBJECTIVES: Papillary muscle rupture (PMR) is a rare but potentially fatal complication of acute myocardial infarction. The aim of this study was to analyse the patient characteristics and early outcomes of the surgical management of post-infarction PMR from an international multicentre registry. METHODS: Patients underwent surgery for post-infarction PMR between 2001 through 2019 were retrieved from database of the CAUTION study. The primary end point was in-hospital mortality. RESULTS: A total of 214 patients were included with a mean age of 66.9 (standard deviation: 10.5) years. The posteromedial papillary muscle was the most frequent rupture location (71.9%); the rupture was complete in 67.3% of patients. Mitral valve replacement was performed in 82.7% of cases. One hundred twenty-two patients (57%) had concomitant coronary artery bypass grafting. In-hospital mortality was 24.8%. Temporal trends revealed no apparent improvement in in-hospital mortality during the study period. Multivariable analysis showed that preoperative chronic kidney disfunction odds ratio (OR): 2.62, 95% confidence interval (CI): 1.07-6.45, P = 0.036, cardiac arrest (OR: 3.99, 95% CI: 1.02-15.61, P = 0.046) and cardiopulmonary bypass duration (OR: 1.01, 95% CI: 1.00-1.02, P = 0.04) were independently associated with an increased risk of in-hospital death, whereas concomitant coronary artery bypass grafting was identified as an independent predictor of early survival (OR: 0.38, 95% CI: 0.16-0.92, P = 0.031). CONCLUSIONS: Surgical treatment for post-infarction PMR carries a high in-hospital mortality rate, which did not improve during the study period. Because concomitant coronary artery bypass grafting confers a survival benefit, this additional procedure should be performed, whenever possible, in an attempt to improve the outcome. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov: NCT03848429.
Massimi et al. (Fri,) conducted a observational in Post-infarction papillary muscle rupture (n=214). Surgical treatment (with or without concomitant coronary artery bypass grafting) was evaluated on In-hospital mortality. Surgical treatment for post-infarction papillary muscle rupture carried a 24.8% in-hospital mortality rate, though concomitant coronary artery bypass grafting improved early survival (OR 0.38; 95% CI 0.16-0.92).