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Vol. 76. Issue 6.
Pages 427-433 (June 2023)
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Vol. 76. Issue 6.
Pages 427-433 (June 2023)
Original article
Mechanical complications in STEMI: prevalence and mortality trends in the primary PCI era. The Ruti-STEMI registry
Complicaciones mecánicas en el IAMCEST: tendencias de prevalencia y mortalidad en la era de la angioplastia primaria. Registro Ruti-STEMI
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Nabil El Ouaddia,
Corresponding author
elouaddi@hotmail.com

Corresponding author.
, Oriol de Diegoa,b,c, Carlos Labataa, Ferran Ruedaa, María José Martíneza, María Luisa Cámarad, Elisabet Berasteguid, Teresa Oliverasa, Marc Ferrera, Santiago Monteroa, Jordi Serraa, Christian Muñoz-Guijosad, Josep Lupóna,e, Antoni Bayés-Genisa,e,f, Cosme García-Garcíaa,e
a Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
b Servicio de Cardiología, Hospital Clínic i Provincial, Barcelona, España
c PhD program, Department of Medicine Autonomous University of Barcelona, Barcelona, España
d Cirugía Cardiaca, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
e Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
f Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
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Figures (1)
Tables (5)
Table 1. Demographic characteristics, medical therapies, and management of ST elevation myocardial infarction patients in the 2 study periods
Table 2. Prevalence and 28-day and 1-year mortality of post-ST-elevation myocardial infarction mechanical complications
Table 3. Baseline characteristics of patients with and without mechanical complications
Table 4. Logistic regression analysis for prevalence of free wall rupture between the 2 periods
Table 5. In-hospital characteristics and management of mechanical complications
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Abstract
Introduction and objectives

Mechanical complications confer a dreadful prognosis in ST-elevation myocardial infarction (STEMI). Their prevalence and prognosis are not well-defined in the current era of primary percutaneous coronary intervention (pPCI) reperfusion networks. We aimed to analyze prevalence and mortality trends of post-STEMI mechanical complications over 2 decades, before and after the establishment of pPCI networks.

Methods

Prospective, consecutive registry of STEMI patients within a region of 850 000 inhabitants over 2 decades: a pre-pPCI period (1990-2000) and a pPCI period (2007-2017). We analyzed the prevalence of mechanical complications, including ventricular septal rupture, papillary muscle rupture, and free wall rupture (FWR). Twenty eight-day and 1-year mortality trends were compared between the 2 studied decades.

Results

A total of 6033 STEMI patients were included (pre-pPCI period, n=2250; pPCI period, n=3783). Reperfusion was supported by thrombolysis in the pre-pPCI period (99.1%) and by pPCI in in the pPCI period (95.7%). Mechanical complications developed in 135 patients (2.2%): ventricular septal rupture in 38 patients, papillary muscle rupture in 24, and FWR in 73 patients. FWR showed a relative reduction of 60% in the pPCI period (0.8% vs 2.0%, P<.001), without significant interperiod changes in the other mechanical complications. After multivariate adjustment, FWR remained higher in the pre-pPCI period (OR, 1.93; 95%CI, 1.10-3.41; P=.023). At 28 days and 1 year, mortality showed no significant changes in all the mechanical complications studied.

Conclusions

The establishment of regional pPCI networks has modified the landscape of mechanical complications in STEMI. FWR is less frequent in the pPCI era, likely due to reduced transmural infarcts.

Keywords:
STEMI
Mechanical complications
Free wall rupture
Heart rupture
Ventricular septal rupture
Ventricular septal defect
Papillary muscle rupture
Primary angioplasty
Primary percutaneous coronary intervention
Abbreviations:
FWR
MC
PMR
pPCI
STEMI
VSR
Resumen
Introducción y objetivos

Las complicaciones mecánicas (CM) confieren un mal pronóstico en el infarto agudo de miocardio con elevación del ST (IAMCEST). Su prevalencia y su pronóstico son inciertos en la era de la angioplastia primaria (AP). Se analizan las tendencias de 2 décadas en la prevalencia y la mortalidad de las CM tras un IAMCEST, antes y después de que se establecieran las redes de AP.

Métodos

Registro prospectivo y consecutivo de pacientes con IAMCEST en una región de 850.000 habitantes durante 2 décadas: periodo previo a la AP (1990-2000) y periodo con AP (2007-2017). Se analiza la prevalencia de CM (comunicación interventricular, rotura del músculo papilar y rotura de la pared libre [RPL]). Se compararon las tendencias de mortalidad a 28 días y 1 año.

Resultados

Se incluyó a 6.033 pacientes con IAMCEST (pre-AP, n=2.250; AP, n=3.783). La reperfusión se apoyó con trombolisis en el periodo pre-AP (99,1%) y mediante AP en el periodo con AP (95,7%). Se produjeron CM en 135 pacientes (2,2%): 38 por comunicación interventricular; 24 por rotura del músculo papilar y 73 por RPL. La RPL mostró una reducción relativa del 60% en el periodo de AP (el 0,8 frente al 2,0%; p<0,001), sin cambios significativos en las demás CM. Después del ajuste multivariable, la RPL sigue siendo mayor en el periodo pre-AP (OR=1,93; IC95%, 1,10-3,41; p=0,023). La mortalidad no mostró cambios significativos en ninguna de las CM.

Conclusiones

El establecimiento de redes regionales de AP ha modificado el panorama de las CM en el IAMCEST. La RPL es menos frecuente en la era de la AP, probablemente debido a la reducción de los infartos transmurales.

Palabras clave:
IAMCEST
Complicaciones mecánicas
Rotura de la pared libre
Rotura cardiaca
Rotura del tabique ventricular
Comunicación interventricular
Rotura del músculo papilar
Angioplastia primaria
Intervención coronaria percutánea primaria

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