Temporal Trends in Mechanical Complications of Acute Myocardial Infarction in the Elderly

Puerto, Elena; Viana-Tejedor, Ana; Martínez‐Sellés, Manuel; Domínguez‐Pérez, Laura; Moreno, Guillermo; Martín‐Asenjo, Roberto; Bueno, Héctor

doi:10.1016/j.jacc.2018.06.031

Cited by 82 publications

(72 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“… 5 Historically, CCUs were developed to monitor for post-infarction complications, such as life threatening ventricular arrhythmias or mechanical sequelae. 38 The incidence of these complications has been greatly reduced by early reperfusion therapy, 39 and most STEMI patients receive definitive reperfusion therapy before admission to an ICU or CCU. Thus, neither the existing literature nor our study precisely identifies what about ICU care might be particularly beneficial to these patients.…”

Section: Discussionmentioning

confidence: 99%

Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study

Valley

Iwashyna

Cooke

et al. 2019

BMJ

View full text Add to dashboard Cite

ObjectiveTo evaluate the effect of intensive care unit (ICU) admission on mortality among patients with ST elevation myocardial infarction (STEMI).DesignRetrospective cohort study.Setting1727 acute care hospitals in the United States.ParticipantsMedicare beneficiaries (aged 65 years or older) admitted with STEMI to either an ICU or a non-ICU unit (general/telemetry ward or intermediate care) between January 2014 and October 2015.Main outcome measure30 day mortality. An instrumental variable analysis was done to account for confounding, using as an instrument the additional distance that a patient with STEMI would need to travel beyond the closest hospital to arrive at a hospital in the top quarter of ICU admission rates for STEMI.ResultsThe analysis included 109 375 patients admitted to hospital with STEMI. Hospitals in the top quarter of ICU admission rates admitted 85% or more of STEMI patients to an ICU. Among patients who received ICU care dependent on their proximity to a hospital in the top quarter of ICU admission rates, ICU admission was associated with lower 30 day mortality than non-ICU admission (absolute decrease 6.1 (95% confidence interval −11.9 to −0.3) percentage points). In a separate analysis among patients with non-STEMI, a group for whom evidence suggests that routine ICU care does not improve outcomes, ICU admission was not associated with differences in mortality (absolute increase 1.3 (−0.9 to 3.4) percentage points).ConclusionsICU care for STEMI is associated with improved mortality among patients who could be treated in an ICU or non-ICU unit. An urgent need exists to identify which patients with STEMI benefit from ICU admission and what about ICU care is beneficial.

show abstract

Section: Discussionmentioning

confidence: 99%

Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study

Valley

Iwashyna

Cooke

et al. 2019

BMJ

View full text Add to dashboard Cite

show abstract

“…In addition, we examined the length of stay and total hospitalization costs. The total duration of hospitalization was shorter (11 [9][10][11][12][13][14][15] vs. 12 [9][10][11][12][13][14][15][16] days, p<0.001), and total hospitalization cost was lower in the GW group than in the CCU group after PSM (1780000 [1480000-2150000] vs. 1830000 [1560000-2240000] JPY, p<0.001)…”

Section: Plos Onementioning

confidence: 99%

“…Management in an intensive care unit/coronary care unit (ICU/CCU) may also improve mortality in patients with acute MI through the monitoring of post-infarction complications, such as life-threatening ventricular arrhythmias or mechanical sequelae [7,8]. However, the impact of CCU had been established before the reperfusion therapy era, although the incidence of complications has been greatly reduced by early reperfusion therapy, particularly primary PCI [9,10]. It is unknown whether CCU is still beneficial to patients with acute MI undergoing primary PCI.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of management of hemodynamically stable patients with acute myocardial infarction following primary percutaneous coronary intervention in the general ward settings

Tateishi

Nakagomi²,

Saito

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

Background Although current guidelines recommend admission to the intensive/coronary care unit (ICU/ CCU) for patients with ST-segment elevation myocardial infarction (MI), routine use of the CCU in uncomplicated patients with acute MI remains controversial. We aimed to evaluate the safety of management in the general ward (GW) of hemodynamically stable patients with acute MI after primary percutaneous coronary intervention (PCI). Methods Using a large nationwide administrative database, a cohort of 19426 patients diagnosed with acute MI in 52 hospitals where a CCU was available were retrospectively analyzed. Patients with mechanical cardiac support and Killip classification 4, and those without primary PCI on admission were excluded. A total of 5736 patients were included and divided into the CCU (n = 3488) and GW (n = 2248) groups according to the type of hospitalization room after primary PCI. Propensity score matching was performed, and 1644 pairs were matched. The primary endpoint was in-hospital mortality at 30 days. Results The CCU group had a higher rate of Killip classification 3 and ambulance use than the GW group. There was no significant difference in the incidence of in-hospital mortality within 30 days among the matched subjects. Multivariable Cox proportional hazard model analysis among unmatched patients supported the findings (hazard ratio 1.12, 95% confidence interval 0.66-1.91, p = 0.67).

show abstract

“…Aortal clamping time varied from 45 to 160 min with a mean of 83.14 min. [21][22] Even though at the Department of Cardiac Surgery, University Hospital Centre "Mother Teresa, Tirana, the mortality is only 11%, however to our best knowledge this rate is underestimated because of the lack of a follow-up program which will present the short/long-term mortality. So, this value reflects only the intraoperative mortality.…”

Section: Main Bodymentioning

confidence: 99%

Surgical treatment of mechanical complications following acute myocardial infarction. A Case Series.

Bucaj¹,

Prifti²

2020

AJTES

View full text Add to dashboard Cite

Background: Acute myocardial infarction can result in ischemic, mechanical, arrhythmic, embolic or inflammatory complications. Despite high operative mortality, the lack of an effective and immediate medical alternative makes the surgery repair the mainstay of current management for these patients. Novel surgical approaches are presented to manage these complications. Main body: Mechanical complications presented at the Department of Cardiac Surgery-Tirana University Medical Centre consisted in nine cases during the period January 2008-June 2018: two anterolateral papillary muscle rupture cases (22%), one posteromedial papillary muscle rupture case (11%), two ventricular septal rupture cases (22%), one free ventricle wall rupture case (11%), three chordae tendineae rupture cases (33%), four out of nine patients (44,5%) underwent concomitant CABG intervention. Intra operator mortality is estimated 11% (one out of nine cases). The Department of Cardiac Surgery-Tirana University Medical Centre is limited only in open surgery techniques for repair the post myocardial infarction mechanical complications. To our personal view key reasons for these results are conditioned from lack of medical devices, trained stuff, reliable short and long outcome data from alternative procedures in order to incorporate thus in our daily practice. Further studies should be undertaken not only to create a precise image of the situation, but also to evaluate the results of the possible changes. Key words: Acute myocardial infarction, mechanical complications, papillary muscle rupture, ventricular septal rupture, free ventricle wall rupture, CABG intervention.

show abstract

Temporal Trends in Mechanical Complications of Acute Myocardial Infarction in the Elderly

Cited by 82 publications

References 20 publications

Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study

Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study

Feasibility of management of hemodynamically stable patients with acute myocardial infarction following primary percutaneous coronary intervention in the general ward settings

Surgical treatment of mechanical complications following acute myocardial infarction. A Case Series.

Contact Info

Product

Resources

About