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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

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Abstract

Mechanical complications (MCs) following acute myocardial infarction (AMI), such as ventricular septal rupture (VSR), free-wall rupture (FWR), and papillary muscle rupture (PMR), are fatal. However, the risk factors of in-hospital mortality among patients with MCs have not been previously reported in Japan. The purpose of this study was to evaluate the prognostic factors of in-hospital mortality in these patients. The study cohort consisted of 233 consecutive patients with MCs from the registry of 10 facilities in the Cardiovascular Research Consortium-8 Universities (CIRC-8U) in East Japan between 1997 and 2014 (2.3% of 10,278 AMI patients). The authors conducted a retrospective observational study to analyse the correlation between the subtypes of MCs with in-hospital mortality, clinical data, and medical treatment. We observed a decreasing incidence of MC (1997–2004: 3.7%, 2005–2010: 2.1%, 2011–2014: 1.9%, p < 0.001). In-hospital mortality among patients with MCs was 46%. Thirty-three percent of patients with MCs were not able to undergo surgical repair due to advanced age or severe cardiogenic shock. In-hospital mortality among patients who had undergone surgical repair was 29% (VSR: 21%, FWR: 33%, PMR: 60%). In patients with MCs, hazard ratio for in-hospital mortality according to multivariate analysis of without surgical repair was 5.63 (95% CI 3.54–8.95). In patients with surgical repair, the hazard ratios of blow-out-type FWR (5.53, 95% confidence interval (CI) 2.22–13.76), those with renal dysfunction (3.11, 95% CI 1.37–7.05), and those receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) (3.79, 95% CI 1.81–7.96) were significantly high. Although primary percutaneous coronary intervention (PCI) is associated with decreased incidence of MCs, high in-hospital mortality persisted in patients with MCs that also presented with renal dysfunction and in those requiring VA-ECMO. Early detection and surgical repair of MCs are essential.

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Acknowledgements

The authors wish to thank Dr. Katamori Sujino, Prof. Yuji Ikari, Assoc. Prof. Nobuaki Suzuki and Prof. Fumihiko Miyake on behalf of the Cardiovascular Research Consortium-8 Universities (CIRC-8U) for their advice on the experimental design and the timely help with analysing the large number of samples. We also very thank the department of cardiovascular surgery in each facility (Iwate Medical University, Kitasato University Kitasato Institute Hospital, Tokai University School of Medicine, Dokkyo Medical University, Dokkyo Medical University Saitama Medical Center, Nikko Medical Center, Dokkyo Medical University, Saitama Medical University, St. Marianna University School of Medicine, Teikyo University School of Medicine, Kyorin University School of Medicine) for providing the clinical data. Finally, we thank Yumiko Okuyama, Kayoko Fujiwara and Shinke Tatsuya on behalf of the cardiovascular research center at Iwate Medical University for their tremendous effort in building the database.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan

    Yorihiko Koeda, Tomonori Itoh, Yu Ishikawa & Yoshihiro Morino

  2. Division of Cardiology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan

    Tomohiro Mizutani & Junya Ako

  3. Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Tokyo, Japan

    Masataka Nakano, Koichiro Yoshioka & Yuji Ikari

  4. Department of Cardiovascular Medicine, Dokkyo Medical University, Shimotsuga, Japan

    Shu Inami & Masashi Sakuma

  5. Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan

    Isao Taguchi & Tetsuya Ishikawa

  6. Division of Cardiology, Nikko Medical Center, Dokkyo Medical University, Nikko, Japan

    Hiroyuki Sugimura

  7. Division of Cardiology, Saitama Medical University, Saitama, Japan

    Keiki Sugi & Kazuo Matsumoto

  8. Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan

    Takanobu Mitarai, Tomoyuki Kunishima & Yoshihiro J. Akashi

  9. Division of Cardiology, Teikyo University School of Medicine, Tokyo, Japan

    Takahiro Nomura

  10. Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan

    Kei Fukushi & Hideaki Yoshino

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  1. Yorihiko Koeda
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Cardiovascular Research Consortium-8 Universities (CIRC-8U)

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Correspondence to Tomonori Itoh.

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Koeda, Y., Itoh, T., Ishikawa, Y. et al. A multicenter study on the clinical characteristics and risk factors of in-hospital mortality in patients with mechanical complications following acute myocardial infarction. Heart Vessels 35, 1060–1069 (2020). https://doi.org/10.1007/s00380-020-01586-0

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