Mechanical complications in ST-elevation myocardial infarction: The impact of pre-hospital delay,International Journal of Cardiology

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Mechanical complications in ST-elevation myocardial infarction: The impact of pre-hospital delay
International Journal of Cardiology ( IF 3.2 ) Pub Date : 2021-10-23 , DOI: 10.1016/j.ijcard.2021.10.020
Frederic Bouisset ₁ , Antoine Deney ₂ , Jean Ferrières ₁ , Vassili Panagides ₃ , Mathieu Becker ₄ , Nicolas Riviere ₅ , Cedric Yvorel ₆ , Philippe Commeau ₇ , Julien Adjedj ₈ , Hakim Benamer ₉ , Guillaume Bonnet ₅ , Guillaume Cayla ₁₀ ,

Affiliation

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.

中文翻译：

ST 段抬高心肌梗死的机械并发症：院前延误的影响

目标

机械并发症（MC）（即游离壁破裂（FWR）、乳头肌破裂（PMR）和室间隔破裂（VSR））是ST段抬高型急性心肌梗死（STEMI）罕见的并发症。根据院前延误的 MC 发病率仍然未知。我们的目的是根据院前延误确定 MC 的发生率。

方法

对 MODIF 注册数据进行了分析。根据院前延迟将患者分为四组：0至12小时、12至24小时、24至36小时和36至48小时。

结果

对6185名数据完整的患者进行了分析。平均年龄为 64.1 岁，75.7% 的患者为男性。83 名患者 (1.34%) 出现 MC：44 名 (0.71%) 经历了 FWR，17 名 (0.27%) 经历了 PMR，22 名 (0.36%) 经历了 VSR。在四组院前延误（0 至 12 小时、12 至 24 小时、24 至 36 小时和 36 至 48 小时）中，MC 的全球发生率分别为 0.82%、1.43%、1.24% 和 5.07%（p <0.001)。住院死亡率很高：FWR、PMR 和 VSR 分别为 44.2%、47.1% 和 54.6%。在多变量分析中，与 MC 发生独立相关的因素是年龄较大、女性、同时感染 COVID-19、没有血脂异常、罪犯动脉中的初始 TIMI 流量为 0 或 1、入院前 36 至 48 小时延迟和经皮冠状动脉介入治疗 (PCI) 支架植入术未进行血运重建。