TY - JOUR
T1 - Long-term survival after surgical treatment for post-infarction mechanical complications
T2 - results from the Caution study
AU - Matteucci, Matteo
AU - Ronco, Daniele
AU - Kowalewski, Mariusz
AU - Massimi, Giulio
AU - De Bonis, Michele
AU - Formica, Francesco
AU - Jiritano, Federica
AU - Folliguet, Thierry
AU - Bonaros, Nikolaos
AU - Sponga, Sandro
AU - Suwalski, Piotr
AU - De Martino, Andrea
AU - Fischlein, Theodor
AU - Troise, Giovanni
AU - Dato, Guglielmo Actis
AU - Serraino, Filiberto Giuseppe
AU - Shah, Shabir Hussain
AU - Scrofani, Roberto
AU - Kalisnik, Jurij Matija
AU - Colli, Andrea
AU - Russo, Claudio Francesco
AU - Ranucci, Marco
AU - Pettinari, Matteo
AU - Kowalowka, Adam
AU - Thielmann, Matthias
AU - Meyns, Bart
AU - Khouqeer, Fareed
AU - Obadia, Jean-Francois
AU - Boeken, Udo
AU - Simon, Caterina
AU - Naito, Shiho
AU - Musazzi, Andrea
AU - Lorusso, Roberto
PY - 2024/2/7
Y1 - 2024/2/7
N2 - BACKGROUND AND AIMS: Mechanical complications (MCs) are rare but potentially fatal sequelae of acute myocardial infarction (AMI). Surgery, though challenging, is considered the treatment of choice. The authors sought to study early and long-term results of patients undergoing surgical treatment for post-AMI MCs. METHODS: Patients undergone surgical treatment for post-infarction MCs between 2001 through 2019 in 27 centers worldwide were retrieved from the database of CAUTION study. In-hospital and long-term mortality were the primary outcomes. Cox proportional hazards regression models were used to determine independent factors associated with overall mortality. RESULTS: The study included 720 patients. The median age was 70.0 [62.0-77.0] years, with a male predominance (64.6%). The most common MC encountered was ventricular septal rupture (VSR) (59.4%). Cardiogenic shock was seen on presentation in 56.1% of patients. In-hospital mortality rate was 37.4%; in more than 50% of cases, the cause of death was low cardiac output syndrome (LCOS). Late mortality occurred in 133 patients, with a median follow-up of 4.4 [1.0-8.6] years. Overall survival at 1, 5 and 10 years was 54.0%, 48.1% and 41.0%, respectively. Older age (p < 0.001) and postoperative LCOS (p < 0.001) were independent predictors of overall mortality. For hospital survivors, 10-year survival was 65.7% and was significant higher for patients with VSR than those with papillary muscle rupture (long-rank P = 0.022). CONCLUSIONS: Contemporary data from a multicenter cohort study show that surgical treatment for post-AMI MCs continues to be associated with high in-hospital mortality rates. However, long-term survival in patients surviving the immediate postoperative period is encouraging.Trial registration number: NCT03848429.
AB - BACKGROUND AND AIMS: Mechanical complications (MCs) are rare but potentially fatal sequelae of acute myocardial infarction (AMI). Surgery, though challenging, is considered the treatment of choice. The authors sought to study early and long-term results of patients undergoing surgical treatment for post-AMI MCs. METHODS: Patients undergone surgical treatment for post-infarction MCs between 2001 through 2019 in 27 centers worldwide were retrieved from the database of CAUTION study. In-hospital and long-term mortality were the primary outcomes. Cox proportional hazards regression models were used to determine independent factors associated with overall mortality. RESULTS: The study included 720 patients. The median age was 70.0 [62.0-77.0] years, with a male predominance (64.6%). The most common MC encountered was ventricular septal rupture (VSR) (59.4%). Cardiogenic shock was seen on presentation in 56.1% of patients. In-hospital mortality rate was 37.4%; in more than 50% of cases, the cause of death was low cardiac output syndrome (LCOS). Late mortality occurred in 133 patients, with a median follow-up of 4.4 [1.0-8.6] years. Overall survival at 1, 5 and 10 years was 54.0%, 48.1% and 41.0%, respectively. Older age (p < 0.001) and postoperative LCOS (p < 0.001) were independent predictors of overall mortality. For hospital survivors, 10-year survival was 65.7% and was significant higher for patients with VSR than those with papillary muscle rupture (long-rank P = 0.022). CONCLUSIONS: Contemporary data from a multicenter cohort study show that surgical treatment for post-AMI MCs continues to be associated with high in-hospital mortality rates. However, long-term survival in patients surviving the immediate postoperative period is encouraging.Trial registration number: NCT03848429.
KW - Acute myocardial infarction
KW - Free-wall rupture
KW - Mechanical complications
KW - Papillary muscle rupture
KW - Surgical treatment
KW - Ventricular septal rupture
U2 - 10.1093/ehjqcco/qcae010
DO - 10.1093/ehjqcco/qcae010
M3 - Article
SN - 2058-5225
JO - European heart journal - Quality of care & clinical outcomes
JF - European heart journal - Quality of care & clinical outcomes
ER -