Author + information
- Received December 31, 2018
- Revision received April 22, 2019
- Accepted April 30, 2019
- Published online September 16, 2019.
- Ayman Elbadawi, MDa,b,
- Islam Y. Elgendy, MDc,∗ (, )@islamelgendy83,
- Karim Mahmoud, MDd,
- Amr F. Barakat, MDe,
- Amgad Mentias, MDf,
- Ahmed H. Mohamed, MDg,
- Gbolahan O. Ogunbayo, MDh,
- Michael Megaly, MDi,j,
- Marwan Saad, MD, PhDb,k,
- Mohamed A. Omer, MDl,
- David Paniagua, MDm,
- J. Dawn Abbott, MDn and
- Hani Jneid, MDm
- aDepartment of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas
- bDivision of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
- cDivision of Cardiovascular Medicine, University of Florida, Gainesville, Florida
- dDepartment of Internal Medicine, Houston Medical Center, Warner Robbins, Georgia
- eHeart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- fDivision of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa
- gDepartment of Internal Medicine, Rochester General Hospital, Rochester, New York
- hDepartment of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
- iDepartment of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota
- jDepartment of Cardiology, Hennepin Healthcare, Minneapolis, Minnesota
- kDivision of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- lDepartment of Cardiovascular Medicine, University of Missouri Kansas City, Kansas City, Missouri
- mDivision of Cardiology, Baylor School of Medicine and the Michael E DeBakey VAMC, Houston, Texas
- nDivision of Cardiovascular Medicine, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
- ↵∗Address for correspondence:
Dr. Islam Y. Elgendy, Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street GRB 800, Boston, Massachusetts 02114.
Objectives The aim of this study was to examine the temporal trends and outcomes of mechanical complications after myocardial infarction in the contemporary era.
Background Data regarding temporal trends and outcomes of mechanical complications after ST-segment elevation myocardial infarction (STEMI) and non–ST-segment elevation myocardial infarction (NSTEMI) are limited in the contemporary era.
Methods The National Inpatient Sample database (2003 to September 2015) was queried to identify all STEMI and NSTEMI hospitalizations. Temporal trends and outcomes of mechanical complications after STEMI and NSTEMI, including papillary muscle rupture, ventricular septal defect, and free wall rupture, were described.
Results The analysis included 3,951,861 STEMI and 5,114,270 NSTEMI hospitalizations. Mechanical complications occurred in 10,726 of STEMI hospitalizations (0.27%) and 3,041 of NSTEMI hospitalizations (0.06%), with no changes in trends (p = 0.13 and p = 0.83, respectively). The rates of in-hospital mortality in patients with mechanical complications were 42.4% after STEMI and 18.0% after NSTEMI, with no significant trend changes (p = 0.62 and p = 0.12, respectively). After multivariate adjustment, patients who had mechanical complications after myocardial infarction had higher in-hospital mortality, cardiogenic shock, acute kidney injury, hemodialysis, and respiratory complications compared with those without mechanical complications. Predictors of lower mortality in patients with mechanical complications who developed cardiogenic shock included surgical repair in the STEMI and NSTEMI cohorts and percutaneous coronary intervention in the STEMI cohort.
Conclusions Contemporary data from a large national database show that the rates of mechanical complications are low in patients presenting with STEMI and NSTEMI. Post–myocardial infarction mechanical complications continue to be associated with high mortality rates, which did not improve during the study period.
Dr. Elgendy's current address is Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 31, 2018.
- Revision received April 22, 2019.
- Accepted April 30, 2019.
- 2019 American College of Cardiology Foundation
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