title: Mechanical complications after percutaneous coronary intervention in ST-elevation myocardial infarction (from APEX-AMI).
abstract: 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.
authors.affiliation: Cardiology Department, University of New South Wales, Sydney, New South Wales, Australia. j.french@unsw.edu.au
authors.forename: John K
authors.initials: JK
authors.lastname: French
authors.forename: Anne S
authors.initials: AS
authors.lastname: Hellkamp
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
authors.forename: Eric
authors.initials: E
authors.lastname: Cohen
authors.forename: Neil S
authors.initials: NS
authors.lastname: Kleiman
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation*; D004562:Electrocardiography; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006335:Heart Injuries / Q000209:etiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends