Rupture of Papillary Muscle and Chordae Tendinae Complicating STEMI: A Call for Action
Rupture of Papillary Muscle and Chordae Tendinae Complicating STEMI: A Call for Action
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DOI：
10.1097/mat.0000000000001299
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发表时间：
2021-08-01
期刊：
影响因子：
4.2
通讯作者：
Burkhoff, Daniel
中科院分区：
文献类型：
--
作者：
Pahuja, Mohit;Ranka, Sagar;Burkhoff, Daniel
乳头肌断裂（PMR）或腱索断裂（CTR）是ST段抬高型心肌梗死（STEMI）后罕见但致命的并发症。由于这种情况的罕见性，有有限的研究定义其流行病学和结果。这是一项来自2002年至2014年全国住院患者样本数据库的回顾性研究，涉及STEMI和PMR/CTR患者。关注的结局为破裂和非破裂患者的院内死亡率、心源性休克（CS）、机械循环支持（MCS）器械使用率和二尖瓣手术（MVP）发生率。我们还使用心血管模型进行了模拟，以更好地了解重度二尖瓣返流的血流动力学以及不同药物和器械治疗的影响。我们确定了1，888例STEMI合并PMR/CTR的患者。大多数患者年龄>65岁（65.3%），男性（63.6%）和白色（82.3%）。他们的CS、心脏骤停和MCS器械使用率显著较高。破裂患者的住院死亡率较高（41% vs. 7.40%，p < 0.001），在研究期间保持不变。住院费用和住院时间也较高。MVP和血运重建导致更好的生存率（27.9% vs. 60.6%，调整后OR：0.14; 95% CI：0.10-0.19; p < 0.001）。尽管血运重建策略取得了重大进展，但STEMI后的PMR/CTR仍预示着预后不良，住院死亡率高。心源性休克是一种常见的临床表现，与住院死亡率显著相关。未来的研究需要确定改善STEMI伴PMR/CTR和CS患者结局的最佳策略。
Papillary muscle rupture (PMR) or chordae tendinae rupture (CTR) is a rare but lethal complication after ST elevation myocardial infarction (STEMI). Due to the rarity of this condition, there are limited studies defining its epidemiology and outcomes. This is a retrospective study from Nationwide Inpatient Sample database from 2002 to 2014 of patients with STEMI and PMR/CTR. Outcomes of interest were incidence of in-hospital mortality, cardiogenic shock (CS), utilization of mechanical circulatory support (MCS) devices and mitral valve procedures (MVPs) among patients with and without rupture. We also performed simulation using the cardiovascular model to better understand the hemodynamics of severe mitral regurgitation and effects of different medications and device therapy. We identified 1,888 patients with STEMI complicated with PMR/CTR. Most of the patients were >65 years of age (65.3%), male (63.6%), and white (82.3%). They had significantly higher incidence of CS, cardiac arrest, and utilization of MCS devices. In-hospital mortality was higher in patients with rupture (41% vs. 7.40%, p < 0.001) which remained unchanged over the study period. Hospitalization cost and length of stay was also higher in them. MVP and revascularization led to better survival rates (27.9% vs. 60.6%, adjusted OR: 0.14; 95% CI: 0.10-0.19; p < 0.001). Despite significant advancement in the revascularization strategy, PMR/CTR after STEMI continues to portend poor prognosis with high inpatient mortality. Cardiogenic shock is a common presentation and is associated with significantly inpatient mortality. Future studies are needed determine the best strategies to improve outcomes in patients with STEMI with PMR/CTR and CS.