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. 2019 Feb 22;14(2):e0209502.
doi: 10.1371/journal.pone.0209502. eCollection 2019.

Mechanical complications in patients with ST-segment elevation myocardial infarction: A single centre experience

Jonas Lanz  1 , Dörte Wyss  2 , Lorenz Räber  1 , Stefan Stortecky  1 , Lukas Hunziker  1 , Stefan Blöchlinger  1 , David Reineke  2 , Lars Englberger  2 , Thomas Zanchin  1 , Marco Valgimigli  1 , Dik Heg  3   4 , Stephan Windecker  1 , Thomas Pilgrim  1
Affiliations

Mechanical complications in patients with ST-segment elevation myocardial infarction: A single centre experience

Jonas Lanz et al. PLoS One. .

Abstract

Background: The study aims to assess characteristics and outcomes of patients suffering a mechanical complication (MC) after ST-segment elevation myocardial infarction (STEMI) in a contemporary cohort of patients in the percutaneous coronary intervention era.

Methods and results: This retrospective single-center cohort study encompasses 2508 patients admitted with STEMI between March 9, 2009 and June 30, 2014. A total of 26 patients (1.1%) suffered a mechanical complication: ventricular septal rupture (VSR) in 17, ventricular free wall rupture (VFWR) in 2, a combination of VSD and VFWR in 2, and papillary muscle rupture (PMR) in 5 patients. Older age (74.5 ± 10.4 years versus 63.9 ± 13.1 years, p < 0.001), female sex (42.3% versus 23.3%, p = 0.034), and a longer latency period between symptom onset and angiography (> 24h: 42.3% versus 16.2%, p = 0.002) were more frequent among patients with MC as compared to patients without MC. The majority of MC patients had multivessel disease (77%) and presented in cardiogenic shock (Killip class IV: 73.1%). Nine patients (7 VSR, 2 VFWR & VSR) were treated conservatively and died. Out of the remaining 10 VSR patients, four underwent surgery, three underwent implantation of an occluder device, and another three patients had surgical repair following occluder device implantation. All patients with isolated VFWR and PMR underwent emergency surgery. At 30 days, mortality for VSR, VFWR, VFWR & VSR and PMR amounted to 71%, 50%, 100% and 0%, respectively.

Conclusions: Despite advances in the management of STEMI patients, mortality of mechanical complications stays considerable in this contemporary cohort. Older age, female sex, and a prolonged latency period between symptom onset and angiography are associated with the occurrence of these complications.

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Conflict of interest statement

None of the authors has competing interests relevant to the submitted research to disclose. The following relationships outside the submitted work are disclosed by the authors: Lorenz Räber received research grants from Abbott, Heartflow, Sanofi and Regeneron and Speaker fees from Abbott, Amgen, Astra Zeneca, Biotronik, CSL Behring, Sanofi, and Regeneron. David Reineke received proctoring fees from Abbott. Marco Valgimigli reports grants from The Medicines Company, grants from Terumo, during the conduct of the study; grants and personal fees from AstraZeneca, personal fees and nonfinancial support from The Medicines Company, personal fees from Terumo, St Jude Vascular, Alvimedica, Abbott Vascular, and Correvio. Stephan Windecker reports having received research grants to the institution from Abbott, Amgen, Bayer, Biotronik, Boston Scientific, Edwards, Medtronic, and St Jude. Thomas Pilgrim reports having received research grants to the institution from Biotronik, Symetis, and Edwards Lifesciences; speaker fees from Boston Scientific. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Study flowchart.
2508 patients with ST-elevation myocardial infarction (STEMI) admitted for percutaneous coronary intervention at the University Hospital Bern between March 9, 2009 and June 30, 2014. 26 suffered a mechanical complication. STEMI, ST-elevation myocardial infarction; VSD, ventricular septal defect; VFWR, ventricular free wall rupture; PMR, papillary muscle rupture; * first patient lost to follow-up at day 26, second one at day 358; † regarding non-lethal clinical endpoints.
Fig 2
Fig 2. Survival curves.
Depicted are survival curves for all-cause mortality based on the product-limit estimator comparing patients with and patients without a mechanical complication in the context of an ST-elevation myocardial infarction.
See this image and copyright information in PMC

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