Mechanical complications after percutaneous coronary intervention in ST-elevation myocardial infarction (from APEX-AMI).

Published

Journal Article

A decrease in mechanical complications after ST-elevation myocardial infarction may have contributed to improved survival rates associated with reperfusion by primary percutaneous coronary intervention (PCI). Mechanical complications occurred in 52 of 5,745 patients (0.91%) in the largest reported randomized trial in which primary PCI was the reperfusion strategy. The frequencies were 0.52% (30) for cardiac free-wall rupture (tamponade), 0.17% (10) for ventricular septal rupture, and 0.26% (15) for papillary muscle rupture (3 patients had 2 complications). Ninety-day survival rates were 37% (11) for cardiac free-wall rupture, 20% (2) for ventricular septal rupture, and 73.3% (11) for papillary muscle rupture. These mechanical complications occurred at a median of 23.5 hours (interquartile range 5.0 to 76.8) after symptom onset and were associated with 44% (23 of 52) survival through 90 days, which accounted for 11% of the 90-day mortality. Factors associated with mechanical complications were older age, female gender, Q waves, presence of radiologic pulmonary edema, and increased prerandomization troponin levels. In conclusion, rates of mechanical complications are lower with primary PCI than those previously reported after fibrinolytic therapy.

Full Text

Duke Authors

Cited Authors

  • French, JK; Hellkamp, AS; Armstrong, PW; Cohen, E; Kleiman, NS; O'Connor, CM; Holmes, DR; Hochman, JS; Granger, CB; Mahaffey, KW

Published Date

  • January 1, 2010

Published In

Volume / Issue

  • 105 / 1

Start / End Page

  • 59 - 63

PubMed ID

  • 20102891

Pubmed Central ID

  • 20102891

Electronic International Standard Serial Number (EISSN)

  • 1879-1913

Digital Object Identifier (DOI)

  • 10.1016/j.amjcard.2009.08.653

Language

  • eng

Conference Location

  • United States