PMID- 32239276 OWN - NLM STAT- MEDLINE DCOM- 20201207 LR - 20201214 IS - 1615-2573 (Electronic) IS - 0910-8327 (Linking) VI - 35 IP - 8 DP - 2020 Aug TI - A multicenter study on the clinical characteristics and risk factors of in-hospital mortality in patients with mechanical complications following acute myocardial infarction. PG - 1060-1069 LID - 10.1007/s00380-020-01586-0 [doi] AB - 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. FAU - Koeda, Yorihiko AU - Koeda Y AD - Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan. FAU - Itoh, Tomonori AU - Itoh T AD - Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan. tomoitoh@iwate-med.ac.jp. FAU - Ishikawa, Yu AU - Ishikawa Y AD - Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan. FAU - Morino, Yoshihiro AU - Morino Y AD - Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan. FAU - Mizutani, Tomohiro AU - Mizutani T AD - Division of Cardiology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan. FAU - Ako, Junya AU - Ako J AD - Division of Cardiology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan. FAU - Nakano, Masataka AU - Nakano M AD - Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Tokyo, Japan. FAU - Yoshioka, Koichiro AU - Yoshioka K AD - Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Tokyo, Japan. FAU - Ikari, Yuji AU - Ikari Y AD - Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Tokyo, Japan. FAU - Inami, Shu AU - Inami S AD - Department of Cardiovascular Medicine, Dokkyo Medical University, Shimotsuga, Japan. FAU - Sakuma, Masashi AU - Sakuma M AD - Department of Cardiovascular Medicine, Dokkyo Medical University, Shimotsuga, Japan. FAU - Taguchi, Isao AU - Taguchi I AD - Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan. FAU - Ishikawa, Tetsuya AU - Ishikawa T AD - Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan. FAU - Sugimura, Hiroyuki AU - Sugimura H AD - Division of Cardiology, Nikko Medical Center, Dokkyo Medical University, Nikko, Japan. FAU - Sugi, Keiki AU - Sugi K AD - Division of Cardiology, Saitama Medical University, Saitama, Japan. FAU - Matsumoto, Kazuo AU - Matsumoto K AD - Division of Cardiology, Saitama Medical University, Saitama, Japan. FAU - Mitarai, Takanobu AU - Mitarai T AD - Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan. FAU - Kunishima, Tomoyuki AU - Kunishima T AD - Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan. FAU - Akashi, Yoshihiro J AU - Akashi YJ AD - Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan. FAU - Nomura, Takahiro AU - Nomura T AD - Division of Cardiology, Teikyo University School of Medicine, Tokyo, Japan. FAU - Fukushi, Kei AU - Fukushi K AD - Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan. FAU - Yoshino, Hideaki AU - Yoshino H AD - Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan. CN - Cardiovascular Research Consortium-8 Universities (CIRC-8U) LA - eng PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Observational Study DEP - 20200401 PL - Japan TA - Heart Vessels JT - Heart and vessels JID - 8511258 SB - IM MH - Aged MH - Aged, 80 and over MH - Female MH - Heart Rupture, Post-Infarction/*mortality/physiopathology/therapy MH - *Hospital Mortality MH - Hospitalization MH - Humans MH - Incidence MH - Japan/epidemiology MH - Male MH - Middle Aged MH - Myocardial Infarction/*mortality/physiopathology/therapy MH - Registries MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Shock, Cardiogenic/*mortality/physiopathology/therapy MH - Time Factors MH - Treatment Outcome OTO - NOTNLM OT - Cardiogenic shock OT - In-hospital mortality OT - Mechanical complications OT - Surgical repair EDAT- 2020/04/03 06:00 MHDA- 2020/12/15 06:00 CRDT- 2020/04/03 06:00 PHST- 2019/11/05 00:00 [received] PHST- 2020/03/13 00:00 [accepted] PHST- 2020/04/03 06:00 [pubmed] PHST- 2020/12/15 06:00 [medline] PHST- 2020/04/03 06:00 [entrez] AID - 10.1007/s00380-020-01586-0 [pii] AID - 10.1007/s00380-020-01586-0 [doi] PST - ppublish SO - Heart Vessels. 2020 Aug;35(8):1060-1069. doi: 10.1007/s00380-020-01586-0. Epub 2020 Apr 1.