Outcomes and Hospital Utilization in Patients With Papillary Muscle Rupture Associated With Acute Myocardial Infarction

Bhardwaj, Bhaskar; Sidhu, G.I.; Balla, Sudarshan; Kumar, Varun; Kumar, Arun; Aggarwal, Kul; Dohrmann, Mary L.; Alpert, Martin A.

doi:10.1016/j.amjcard.2019.12.051

Cited by 37 publications

(39 citation statements)

References 25 publications

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“…PMR is a very rare condition, especially in the modern era. The APEX-AMI trial, which recruited patients with ST-elevation myocardial infarction from 17 countries and 296 sites from 2004 to 2006, found a 0.26% incidence of PMR following AMI; more recently that rate was 0.029%, according to data derived from the National Inpatient Sample in the USA from 2005 to 2014 [ 3 , 4 ]. Our study included data from 196 patients in the JCVSD, which captured clinical information from 99% of Japanese hospitals that performed cardiovascular surgery from 2014 to 2017 (4 years).…”

Section: Discussionmentioning

confidence: 99%

Mitral valve surgery for ischemic papillary muscle rupture: outcomes from the Japan cardiovascular surgery database

Fujita

Yamamoto

Kobayashi

et al. 2020

Gen Thorac Cardiovasc Surg

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Background Ischemic papillary muscle rupture (PMR) is a catastrophic complication following acute myocardial infarction (AMI). We evaluated early outcomes of PMR by using data from the Japan Cardiovascular Surgery Database, a nationwide Japanese registry. Methods We retrospectively analyzed data from 196 patients diagnosed with PMR following AMI in Japan between January 2014 and December 2017. Risk factors for operative mortality and severe complications following mitral valve surgery were analyzed. Results The 30-day and hospital mortality rates were 20% and 26%, respectively. Chronic hemodialysis, abrupt rupture after AMI, resuscitation before surgery, and preoperative venoarterial extracorporeal membrane oxygenation were associated with mortality. Mitral valve replacement was chosen mainly (90%) for surgical correction of mitral regurgitation in these patients. There was no significant difference in short-term outcomes between mitral valve replacement versus mitral valve repair, despite non-matched characteristics in background between the treatment groups. Concomitant coronary artery bypass grafting had no impact on short-term outcomes. Conclusions Information derived from the nationwide database of patients with AMI-associated PMR show that PMR is a rare condition in the modern era. However, PMR is a severe disease with a mortality rate as high as 26%. The severity of the condition is associated with the risk for poor outcomes. Electronic supplementary material The online version of this article (10.1007/s11748-020-01418-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Mitral valve surgery for ischemic papillary muscle rupture: outcomes from the Japan cardiovascular surgery database

Fujita

Yamamoto

Kobayashi

et al. 2020

Gen Thorac Cardiovasc Surg

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“…Answer 5: Acute MR secondary to PMR is a rare, but potentially fatal, mechanical complication of AMI. Although the incidence of PMR has decreased significantly from 1% to 5% to <0.03% in the era of primary percutaneous coronary intervention, the mortality rate remains high ( 7 , 8 ). PMR results in acute, severe MR, which leads to flash pulmonary edema, hypotension, and cardiogenic shock often requiring mechanical support ( 7 ).…”

Section: Question 5: Under Which Circumstances Is Pmr Most Likely To Occur?mentioning

confidence: 99%

“…Although the incidence of PMR has decreased significantly from 1% to 5% to <0.03% in the era of primary percutaneous coronary intervention, the mortality rate remains high ( 7 , 8 ). PMR results in acute, severe MR, which leads to flash pulmonary edema, hypotension, and cardiogenic shock often requiring mechanical support ( 7 ). PMR more commonly involves the posteromedial papillary muscle, given its solitary blood supply from the posterior descending artery.…”

Section: Question 5: Under Which Circumstances Is Pmr Most Likely To Occur?mentioning

confidence: 99%

Papillary Muscle Rupture Complicating Acute Myocardial Infarction

et al. 2020

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“…Mitral regurgitation (MR) complicating acute Myocaridial Infarction (MI) can be the result of papillary muscle rupture (Primary) or imbalance between closing and tethering forces (Functional). Primary MR in this acute setting is a medical emergency often requires emergent intervention [ 1 ]. Functional mitral regurgitation (FMR) usually develops over the course of days and is associated with adverse outcomes [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Safety and Feasibility of MitraClip Implantation in Patients with Acute Mitral Regurgitation after Recent Myocardial Infarction and Severe Left Ventricle Dysfunction

Haberman

Estévez‐Loureiro

Benito‐González

et al. 2021

JCM

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Patients with severe mitral regurgitation (MR) after myocardial infarction (MI) have an increased risk of mortality. Transcatheter mitral valve repair may therefore be a suitable therapy. However, data on clinical outcomes of patients in an acute setting are scarce, especially those with reduced left ventricle (LV) dysfunction. We conducted a multinational, collaborative data analysis from 21 centers for patients who were, within 90 days of acute MI, treated with MitraClip due to severe MR. The cohort was divided according to median left ventricle ejection fraction (LVEF)—35%. Included in the study were 105 patients. The mean age was 71 ± 10 years. Patients in the LVEF < 35% group were younger but with comparable Euroscore II, multivessel coronary artery disease, prior MI and coronary artery bypass graft surgery. Procedure time was comparable and acute success rate was high in both groups (94% vs. 90%, p = 0.728). MR grade was significantly reduced in both groups along with an immediate reduction in left atrial V-wave, pulmonary artery pressure and improvement in New York Heart Association (NYHA) class. In-hospital and 1-year mortality rates were not significantly different between the two groups (11% vs. 7%, p = 0.51 and 19% vs. 12%, p = 0.49) and neither was the 3-month re-hospitalization rate. In conclusion, MitraClip intervention in patients with acute severe functional mitral regurgitation (FMR) due to a recent MI in an acute setting is safe and feasible. Even patients with severe LV dysfunction may benefit from transcatheter mitral valve intervention and should not be excluded.

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Outcomes and Hospital Utilization in Patients With Papillary Muscle Rupture Associated With Acute Myocardial Infarction

Cited by 37 publications

References 25 publications

Mitral valve surgery for ischemic papillary muscle rupture: outcomes from the Japan cardiovascular surgery database

Mitral valve surgery for ischemic papillary muscle rupture: outcomes from the Japan cardiovascular surgery database

Papillary Muscle Rupture Complicating Acute Myocardial Infarction

Safety and Feasibility of MitraClip Implantation in Patients with Acute Mitral Regurgitation after Recent Myocardial Infarction and Severe Left Ventricle Dysfunction

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