OBJECTIVES Papillary muscle rupture (PMR) is a rare but potentially fatal complication of acute myocardial infarction. The aim of this study was to analyse the patient characteristics and early outcomes of the surgical management of post-infarction PMR from an international multicentre registry. METHODS Patients underwent surgery for post-infarction PMR between 2001 through 2019 were retrieved from database of the CAUTION study. The primary end point was in-hospital mortality. RESULTS A total of 214 patients were included with a mean age of 66.9 (standard deviation: 10.5) years. The posteromedial papillary muscle was the most frequent rupture location (71.9%); the rupture was complete in 67.3% of patients. Mitral valve replacement was performed in 82.7% of cases. One hundred twenty-two patients (57%) had concomitant coronary artery bypass grafting. In-hospital mortality was 24.8%. Temporal trends revealed no apparent improvement in in-hospital mortality during the study period. Multivariable analysis showed that preoperative chronic kidney disfunction [odds ratio (OR): 2.62, 95% confidence interval (CI): 1.07–6.45, P = 0.036], cardiac arrest (OR: 3.99, 95% CI: 1.02–15.61, P = 0.046) and cardiopulmonary bypass duration (OR: 1.01, 95% CI: 1.00–1.02, P = 0.04) were independently associated with an increased risk of in-hospital death, whereas concomitant coronary artery bypass grafting was identified as an independent predictor of early survival (OR: 0.38, 95% CI: 0.16–0.92, P = 0.031). CONCLUSIONS Surgical treatment for post-infarction PMR carries a high in-hospital mortality rate, which did not improve during the study period. Because concomitant coronary artery bypass grafting confers a survival benefit, this additional procedure should be performed, whenever possible, in an attempt to improve the outcome. Clinical trial registration clinicaltrials.gov: NCT03848429.

中文翻译：

---

梗死后乳头肌破裂的手术治疗：一项多中心研究

目的 乳头肌破裂 (PMR) 是一种罕见但可能致命的急性心肌梗死并发症。本研究的目的是分析来自国际多中心登记处的梗死后 PMR 手术治疗的患者特征和早期结果。方法 从 CAUTION 研究的数据库中检索 2001 年至 2019 年期间因梗死后 PMR 接受手术的患者。主要终点是住院死亡率。结果共纳入214名患者，平均年龄为66.9（标准差：10.5）岁。后内侧乳头肌是最常见的破裂部位（71.9%）；67.3%的患者完全破裂。82.7% 的病例进行了二尖瓣置换术。122 名患者（57%）同时进行了冠状动脉旁路移植术。住院死亡率为24.8%。时间趋势显示，研究期间住院死亡率没有明显改善。多变量分析显示术前慢性肾功能不全[优势比 (OR): 2.62, 95% 置信区间 (CI): 1.07–6.45, P = 0.036], 心脏骤停 (OR: 3.99, 95% CI: 1.02–15.61, P = 0.046) 和体外循环持续时间 (OR: 1.01, 95% CI: 1.00–1.02, P = 0.04) 与院内死亡风险增加独立相关，而伴随冠状动脉旁路移植术被确定为独立预测因素早期生存（OR：0.38，95% CI：0.16-0.92，P = 0.031）。结论 梗死后 PMR 的手术治疗具有很高的住院死亡率，在研究期间没有改善。由于伴随的冠状动脉旁路移植术可带来生存益处，因此应尽可能进行这种额外的手术，以试图改善结果。临床试验注册clinicaltrials.gov：NCT03848429。