PMID- 33093383
OWN - NLM
STAT- MEDLINE
DCOM- 20211015
LR  - 20230821
IS  - 1538-943X (Electronic)
IS  - 1058-2916 (Linking)
VI  - 67
IP  - 8
DP  - 2021 Aug 1
TI  - Rupture of Papillary Muscle and Chordae Tendinae Complicating STEMI: A Call for 
      Action.
PG  - 907-916
LID - 10.1097/MAT.0000000000001299 [doi]
AB  - Papillary muscle rupture (PMR) or chordae tendinae rupture (CTR) is a rare but 
      lethal complication after ST elevation myocardial infarction (STEMI). Due to the 
      rarity of this condition, there are limited studies defining its epidemiology and 
      outcomes. This is a retrospective study from Nationwide Inpatient Sample database 
      from 2002 to 2014 of patients with STEMI and PMR/CTR. Outcomes of interest were 
      incidence of in-hospital mortality, cardiogenic shock (CS), utilization of 
      mechanical circulatory support (MCS) devices and mitral valve procedures (MVPs) 
      among patients with and without rupture. We also performed simulation using the 
      cardiovascular model to better understand the hemodynamics of severe mitral 
      regurgitation and effects of different medications and device therapy. We 
      identified 1,888 patients with STEMI complicated with PMR/CTR. Most of the 
      patients were >65 years of age (65.3%), male (63.6%), and white (82.3%). They had 
      significantly higher incidence of CS, cardiac arrest, and utilization of MCS 
      devices. In-hospital mortality was higher in patients with rupture (41% vs. 
      7.40%, p < 0.001) which remained unchanged over the study period. Hospitalization 
      cost and length of stay was also higher in them. MVP and revascularization led to 
      better survival rates (27.9% vs. 60.6%, adjusted OR: 0.14; 95% CI: 0.10-0.19; p < 
      0.001). Despite significant advancement in the revascularization strategy, 
      PMR/CTR after STEMI continues to portend poor prognosis with high inpatient 
      mortality. Cardiogenic shock is a common presentation and is associated with 
      significantly inpatient mortality. Future studies are needed determine the best 
      strategies to improve outcomes in patients with STEMI with PMR/CTR and CS.
CI  - Copyright (c) ASAIO 2020.
FAU - Pahuja, Mohit
AU  - Pahuja M
AUID- ORCID: 0000-0002-7276-710
AD  - From the Department of Cardiology, Medstar Georgetown University/Washington 
      Hospital Center, Washington, DC.
FAU - Ranka, Sagar
AU  - Ranka S
AUID- ORCID: 0000-0002-2167-6961
AD  - Division of Cardiology, University of Kansas Medical Center, Kansas City, Kansas.
FAU - Chauhan, Kinsuk
AU  - Chauhan K
AUID- ORCID: 0000-0002-1198-3562
AD  - Internal Medicine Department, Wayne State University, Detroit, Michigan.
FAU - Patel, Achint
AU  - Patel A
AD  - Department of Public Health, Icahn School of Medicine at Mount Sinai, New York 
      City, New York.
FAU - Chehab, Omar
AU  - Chehab O
AD  - Department of Internal Medicine, Detroit Medical Center, Wayne State University 
      School of Medicine, Detroit, Michigan.
FAU - Elmoghrabi, Adel
AU  - Elmoghrabi A
AD  - Department of Internal Medicine, Detroit Medical Center, Wayne State University 
      School of Medicine, Detroit, Michigan.
FAU - Mony, Shruti
AU  - Mony S
AD  - Department of Gastroenterology, Johns Hopkins University school of Medicine, 
      Baltimore, Maryland.
FAU - Ando, Tomo
AU  - Ando T
AD  - Division of Cardiology, Department of Internal Medicine, Columbia University 
      Medical Center, New York.
FAU - Mishra, Tushar
AU  - Mishra T
AD  - Department of Internal Medicine, Detroit Medical Center, Wayne State University 
      School of Medicine, Detroit, Michigan.
FAU - Singh, Manmohan
AU  - Singh M
AD  - Department of Internal Medicine, Detroit Medical Center, Wayne State University 
      School of Medicine, Detroit, Michigan.
FAU - Abubaker, Hossam
AU  - Abubaker H
AD  - Division of Cardiology, Department of Internal Medicine, Loma Linda University 
      Medical Center, Los Angeles, California.
FAU - Yassin, Ahmed
AU  - Yassin A
AD  - Internal Medicine Department, Wayne State University, Detroit, Michigan.
FAU - Glazier, James J
AU  - Glazier JJ
AUID- ORCID: 0000-0001-5239-3692
AD  - From the Department of Cardiology, Medstar Georgetown University/Washington 
      Hospital Center, Washington, DC.
FAU - Afonso, Luis
AU  - Afonso L
AD  - From the Department of Cardiology, Medstar Georgetown University/Washington 
      Hospital Center, Washington, DC.
FAU - Kapur, Navin K
AU  - Kapur NK
AD  - Division of Cardiology, Department of Internal Medicine, Tufts University Medical 
      Center, Boston, Massachusetts.
FAU - Burkhoff, Daniel
AU  - Burkhoff D
AUID- ORCID: 0000-0003-3995-2466
AD  - Division of Cardiology, Department of Internal Medicine, Columbia University 
      Medical Center, New York.
AD  - Cardiovascular Research Foundation, New York.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - ASAIO J
JT  - ASAIO journal (American Society for Artificial Internal Organs : 1992)
JID - 9204109
SB  - IM
MH  - Aged
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Papillary Muscles
MH  - Retrospective Studies
MH  - *ST Elevation Myocardial Infarction/complications/surgery
MH  - Shock, Cardiogenic/etiology
COIS- Disclosure: Dr. Burkhoff has received an unrestricted institutional educational 
      grant from Abiomed to CRF. Dr Kapur has received consulting/Speaker Honoraria and 
      research Grants from Abbott, Abiomed, Boston Scientific, LivaNova, Medtronic, 
      Maquet, and MD Start. The other authors have no conflicts of interest to report.
EDAT- 2020/10/24 06:00
MHDA- 2021/10/16 06:00
CRDT- 2020/10/23 05:51
PHST- 2020/10/24 06:00 [pubmed]
PHST- 2021/10/16 06:00 [medline]
PHST- 2020/10/23 05:51 [entrez]
AID - 00002480-202108000-00013 [pii]
AID - 10.1097/MAT.0000000000001299 [doi]
PST - ppublish
SO  - ASAIO J. 2021 Aug 1;67(8):907-916. doi: 10.1097/MAT.0000000000001299.