A multicenter study on the clinical characteristics and risk factors of in-hospital mortality in patients with mechanical complications following acute myocardial infarction

Koeda, Yorihiko; Itoh, Tomonori; Ishikawa, Yu; Morino, Yoshihiro; Mizutani, Tomohiro; Ako, Junya; Yoshioka, Koichiro; Ikari, Yuji; Inami, Shu; Sakuma, Masashi; Tanaka, Isao; Ishikawa, Takahiro; Sugimura, Hiroyuki; Sugi, Keiki; Matsumoto, Kazuo; Mitarai, Takanobu; Kunishima, Tomoyuki; Akashi, Yoshihiro J.; Nomura, Takahiro; Fukushi, Kei; Yoshino, Hideaki

doi:10.1007/s00380-020-01586-0

Cited by 11 publications

(11 citation statements)

References 24 publications

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“…The incidence of post infarction angina in these patients is significantly greater than in patients without ventricular rupture (1,2,3). Delay in treatment and continued physical activity post infarction increases the risk of ventricular rupture (1,2,3).…”

Section: Discussionmentioning

confidence: 99%

“…The pseudoaneurysm ruptured straight into the right ventricle instead of the pericardial cavity and this caused a tiny VSD instead of tamponade (9). Mechanical complications of FWR, VSD and papillary muscle rupture have become rarer in the reperfusion era but still present with devastating complications of MI like cardiogenic shock (1,2). Patients often present with single-vessel coronary artery disease and usually do not have a positive history for a previous myocardial infarction (1,2,3).…”

Section: Discussionmentioning

confidence: 99%

“…Mechanical complications of FWR, VSD and papillary muscle rupture have become rarer in the reperfusion era but still present with devastating complications of MI like cardiogenic shock (1,2). Patients often present with single-vessel coronary artery disease and usually do not have a positive history for a previous myocardial infarction (1,2,3). The incidence of post infarction angina in these patients is significantly greater than in patients without ventricular rupture (1,2,3).…”

Section: Discussionmentioning

confidence: 99%

“…Patients often present with single-vessel coronary artery disease and usually do not have a positive history for a previous myocardial infarction (1,2,3). The incidence of post infarction angina in these patients is significantly greater than in patients without ventricular rupture (1,2,3). Delay in treatment and continued physical activity post infarction increases the risk of ventricular rupture (1,2,3).…”

Section: Discussionmentioning

confidence: 99%

“…Acute myocardial infarction can be associated rarely with deadly mechanical complications resulting from myocardial rupture (1,2). The types of mechanical complications are categorized as ventricular free wall rupture (FWR), ventricular septal rupture (VSD) and papillary muscle rupture (PMR) in decreasing order of incidence (2,3). The FWR has been reported in up to 10% (dropping to 2% currently) of Mis in prereperfusion era while VSD and PMR had a lower incidence of 1-2% and 0.5-5%, respectively (3).…”

Section: Manuscript Introductionmentioning

confidence: 99%

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Left Ventricular and adjacent Right ventricular Pseudoaneurysms post acute myocardial infarction communicating via a Ventricular Septal Defect

Kang

Wilson

Friedel

et al. 2020

Preprint

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The rare but deadly post myocardial infarction (MI) mechanical complications are categorized as ventricular free wall rupture, ventricular septal rupture (VSD) and papillary muscle rupture in decreasing order of incidence. The incidence of the mechanical complications has been mitigated by early revascularization in recent years but mortality remains high. The cardiac rupture if contained by clot, scar and pericardium leads to a LV pseudoaneurysm that delays or diminishes the fatal outcome. Mechanical complications and pseudoaneurysm are recognized by echocardiography. We report a previously unreported occurrence of a pseudoaneurysm involving the adjacent walls of both the ventricles, LV basal and inferoseptal walls and the adjacent right ventricular inferior wall (RV). The LV and RV communicated via a hole in the pseudoaneurysmal wall. The echocardiographic images initially showed the LV pseudoaneurysm bulging into the RV rather than into the pericardium. The color Doppler showed shunting through the LV pseudoaneurysm into the RV creating an unusual VSD. The CT angiograms corroborated the echo findings. The LV pseudoaneurysm had a tear in it and this led to bleeding not into pericardium but into the adjacent RV pseudoaneurysm, hence creating a very unusual VSD. Subsequently, our patient went for surgical repair of pseudoaneurysm and the surgical findings confirmed the imaging findings that there was a massive LV pseudoaneurysm from the inferior and inferoseptal walls, the adjacent RV wall was involved with the pseudoaneurysm and a communication between LV pseudoaneuysm sac and the RV was seen. Such pathology has not been described in the past.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Manuscript Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Left Ventricular and adjacent Right ventricular Pseudoaneurysms post acute myocardial infarction communicating via a Ventricular Septal Defect

Kang

Wilson

Friedel

et al. 2020

Preprint

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Mortality and predictors of survival in patients with recent ventricular septal rupture

et al. 2020

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Association between acute myocardial infarction-to-cardiac rupture time and in-hospital mortality risk: a retrospective analysis of multicenter registry data from the Cardiovascular Research Consortium-8 Universities (CIRC-8U)

et al. 2021

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Despite the known association of cardiac rupture with acute myocardial infarction (AMI), it is still unclear whether the clinical characteristics are associated with the risk of in-hospital mortality in patients with AMI complicated by cardiac rupture. The purpose of this study was to investigate the association between the time of cardiac rupture occurrence and the risk of in-hospital mortality after AMI. We conducted a retrospective analysis of multicenter registry data from eight medical universities in Eastern Japan. From 10,278 consecutive patients with AMI, we included 183 patients who had cardiac rupture after AMI, and examined the incidence of in-hospital deaths during a median follow-up of 26 days. Patients were stratified into three groups according to the AMI-to-cardiac rupture time, namely the > 24-h group (n = 111), 24–48-h group (n = 20), and < 48-h group (n = 52). Cox proportional hazards regression analysis was used to estimate the hazard ratio (HR) and the confidence interval (CI) for in-hospital mortality. Around 87 (48%) patients experienced in-hospital death and 126 (67%) underwent a cardiac surgery. Multivariable Cox regression analysis revealed a non-linear association across the three groups for mortality (HR [CI]; < 24 h: 1.0, reference; 24–48 h: 0.73 [0.27–1.86]; > 48 h: 2.25 [1.22–4.15]) after adjustments for age, sex, Killip classification, percutaneous coronary intervention, blood pressure, creatinine, peak creatine kinase myocardial band fraction, left ventricular ejection fraction, and type of rupture. Cardiac surgery was independently associated with a reduction in the HR of mortality (HR [CI]: 0.27 [0.12–0.61]) and attenuated the association between the three AMI-to-cardiac rupture time categories and mortality (statistically non-significant) in the Cox model. These data suggest that the AMI-to-cardiac rupture time contributes significantly to the risk of in-hospital mortality; however, rapid diagnosis and prompt surgical interventions are crucial for improving outcomes in patients with cardiac rupture after AMI.

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A multicenter study on the clinical characteristics and risk factors of in-hospital mortality in patients with mechanical complications following acute myocardial infarction

Cited by 11 publications

References 24 publications

Left Ventricular and adjacent Right ventricular Pseudoaneurysms post acute myocardial infarction communicating via a Ventricular Septal Defect

Left Ventricular and adjacent Right ventricular Pseudoaneurysms post acute myocardial infarction communicating via a Ventricular Septal Defect

Mortality and predictors of survival in patients with recent ventricular septal rupture

Association between acute myocardial infarction-to-cardiac rupture time and in-hospital mortality risk: a retrospective analysis of multicenter registry data from the Cardiovascular Research Consortium-8 Universities (CIRC-8U)

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