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A multicenter study on the clinical characteristics and risk factors of in-hospital mortality in patients with mechanical complications following acute myocardial infarction.
Koeda, Yorihiko; Itoh, Tomonori; Ishikawa, Yu; Morino, Yoshihiro; Mizutani, Tomohiro; Ako, Junya; Nakano, Masataka; Yoshioka, Koichiro; Ikari, Yuji; Inami, Shu; Sakuma, Masashi; Taguchi, Isao; Ishikawa, Tetsuya; Sugimura, Hiroyuki; Sugi, Keiki; Matsumoto, Kazuo; Mitarai, Takanobu; Kunishima, Tomoyuki; Akashi, Yoshihiro J; Nomura, Takahiro; Fukushi, Kei; Yoshino, Hideaki.
Afiliação
  • Koeda Y; Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan.
  • Itoh T; 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.
  • Ishikawa Y; Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan.
  • Morino Y; Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan.
  • Mizutani T; Division of Cardiology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
  • Ako J; Division of Cardiology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
  • Nakano M; Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Tokyo, Japan.
  • Yoshioka K; Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Tokyo, Japan.
  • Ikari Y; Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Tokyo, Japan.
  • Inami S; Department of Cardiovascular Medicine, Dokkyo Medical University, Shimotsuga, Japan.
  • Sakuma M; Department of Cardiovascular Medicine, Dokkyo Medical University, Shimotsuga, Japan.
  • Taguchi I; Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan.
  • Ishikawa T; Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan.
  • Sugimura H; Division of Cardiology, Nikko Medical Center, Dokkyo Medical University, Nikko, Japan.
  • Sugi K; Division of Cardiology, Saitama Medical University, Saitama, Japan.
  • Matsumoto K; Division of Cardiology, Saitama Medical University, Saitama, Japan.
  • Mitarai T; Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
  • Kunishima T; Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
  • Akashi YJ; Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
  • Nomura T; Division of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
  • Fukushi K; Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan.
  • Yoshino H; Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan.
Heart Vessels ; 35(8): 1060-1069, 2020 Aug.
Article em En | MEDLINE | ID: mdl-32239276
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.
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Texto completo: 1 Eixos temáticos: Pesquisa_clinica Base de dados: MEDLINE Assunto principal: Choque Cardiogênico / Ruptura Cardíaca Pós-Infarto / Mortalidade Hospitalar / Infarto do Miocárdio Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged País como assunto: Asia Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Eixos temáticos: Pesquisa_clinica Base de dados: MEDLINE Assunto principal: Choque Cardiogênico / Ruptura Cardíaca Pós-Infarto / Mortalidade Hospitalar / Infarto do Miocárdio Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged País como assunto: Asia Idioma: En Ano de publicação: 2020 Tipo de documento: Article