Frederic Bouisset1, Antoine Deney2, Jean Ferrières3, Vassili Panagides4, Mathieu Becker5, Nicolas Riviere6, Cedric Yvorel7, Philippe Commeau8, Julien Adjedj9, Hakim Benamer10, Guillaume Bonnet6, Guillaume Cayla11. 1. Centre Hospitalier Universitaire de Toulouse, Hôpital Rangueil, Toulouse, France; Department of Epidemiology INSERM UMR 1027, Toulouse, France. Electronic address: bouisset.f@chu-toulouse.fr. 2. Centre Hospitalier Universitaire de Toulouse, Hôpital Rangueil, Toulouse, France. 3. Centre Hospitalier Universitaire de Toulouse, Hôpital Rangueil, Toulouse, France; Department of Epidemiology INSERM UMR 1027, Toulouse, France. 4. Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France. 5. CHR Metz -Thionville, Metz Hopital de Mercy, Metz, France. 6. University of Bordeaux, Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France. 7. CHU de Saint Etienne, Saint Priest-en-Jarez, France. 8. Polyclinique Les Fleurs, Elsan, Ollioules, France. 9. Institute Arnaud Tzanck, Saint Laurent du Var, France. 10. Institut Jacques Cartier, Ramsay Générale de Santé, ICPS, Massy, France. 11. Cardiology Department, Nimes University Hospital, Montpellier University, Nimes, France.
Abstract
AIMS: Mechanical complications (MC) (i.e., free wall rupture (FWR), papillary muscle rupture (PMR) and ventricular septal rupture (VSR)) are rare complications of ST- elevation acute myocardial infarction (STEMI). Incidence of MC according to pre-hospital delay remains unknown. We aimed to determine the rates of MC according to pre-hospital delay. METHODS: Analysis was conducted on the MODIF registry data. Patients were allocated to four groups according to pre-hospital delay: 0 to 12 h, 12 to 24 h, 24 to 36 h and 36 to 48 h. RESULTS: 6185 patients with complete data were analyzed. Mean age was 64.1 years old and 75.7% of patients were males. Eighty-three patients (1.34%) presented with MC: 44 (0.71%) experienced a FWR, 17 (0.27%) a PMR, and 22 (0.36%) a VSR. Global rates of MC were 0.82%, 1.43%, 1.24% and 5.07% in the four groups of pre-hospital delays - 0 to 12 h, 12 to 24 h, 24 to 36 h and 36 to 48 h - respectively (p < 0.001). In-hospital mortality rates were high: 44.2%, 47.1% and 54.6% for FWR, PMR and VSR, respectively. In multivariate analysis, factors independently related to the occurrence of MC were older age, female sex, simultaneous COVID-19 infection, absence of dyslipidemia, initial TIMI flow 0 or 1 in the culprit artery, 36 to 48 h-pre-hospital delay and absence of revascularization by percutaneous coronary intervention (PCI) with stent implantation. CONCLUSION: The probability of MC in STEMI increases with pre-hospital delay. Mechanical complications of STEMI remain associated with a very poor prognosis.
AIMS: Mechanical complications (MC) (i.e., free wall rupture (FWR), papillary muscle rupture (PMR) and ventricular septal rupture (VSR)) are rare complications of ST- elevation acute myocardial infarction (STEMI). Incidence of MC according to pre-hospital delay remains unknown. We aimed to determine the rates of MC according to pre-hospital delay. METHODS: Analysis was conducted on the MODIF registry data. Patients were allocated to four groups according to pre-hospital delay: 0 to 12 h, 12 to 24 h, 24 to 36 h and 36 to 48 h. RESULTS: 6185 patients with complete data were analyzed. Mean age was 64.1 years old and 75.7% of patients were males. Eighty-three patients (1.34%) presented with MC: 44 (0.71%) experienced a FWR, 17 (0.27%) a PMR, and 22 (0.36%) a VSR. Global rates of MC were 0.82%, 1.43%, 1.24% and 5.07% in the four groups of pre-hospital delays - 0 to 12 h, 12 to 24 h, 24 to 36 h and 36 to 48 h - respectively (p < 0.001). In-hospital mortality rates were high: 44.2%, 47.1% and 54.6% for FWR, PMR and VSR, respectively. In multivariate analysis, factors independently related to the occurrence of MC were older age, female sex, simultaneous COVID-19 infection, absence of dyslipidemia, initial TIMI flow 0 or 1 in the culprit artery, 36 to 48 h-pre-hospital delay and absence of revascularization by percutaneous coronary intervention (PCI) with stent implantation. CONCLUSION: The probability of MC in STEMI increases with pre-hospital delay. Mechanical complications of STEMI remain associated with a very poor prognosis.
Authors: Cristiano Spadaccio; Angelo Pisani; Antonio Salsano; Antonio Nenna; Alexander Fardman; David D'Alessandro; Francesco Santini; Mario F L Gaudino; Thoralf M Sundt; David Rose Journal: Open Med (Wars) Date: 2022-09-06
Authors: Marco Penso; Antonio Frappampina; Nicola Cosentino; Gloria Tamborini; Fabrizio Celeste; Monica Ianniruberto; Paolo Ravagnani; Sarah Troiano; Giancarlo Marenzi; Mauro Pepi Journal: Front Cardiovasc Med Date: 2022-10-03