Mechanical complications of acute myocardial infarction considering risk factors, treatment and survival of patients in 10-year clinical observation
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Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
Students’ Scientific Club, Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
2nd Department of Cardiology and Department of Anaesthesiology and Intensive Care, Independent Public Clinical Hospital No. 7, Leszek Giec Upper-Silesian Medical Centre, Medical University of Silesia, Katowice, Poland
Józefa Dąbek   

Katedra i Klinika Kardiologii, Wydział Nauk o Zdrowiu w Katowicach, Śląski Uniwersytet Medyczny w Katowicach, ul. Ziołowa 47, 40-635 Katowice
Ann. Acad. Med. Siles. 2019;73:119–129
Cardiovascular diseases, including coronary disease and its complications, are the most common cause of death. Myocardial infarction is usually caused by a blood clot cosing the lumen of a coronary artery at the site of an unstable atherosclerotic plaque.

Material and methods:
All the analyzed patients with mechanical complications of acute myocardial infarction (AMI) were hospitalized at the 2nd Department of Cardiology and Department of Anaesthesiology and Intensive Care of the Upper-Silesian Medical Centre in Katowice in 2006–2016 and the database was based on the medical records of the patients. The study group comprised 52 (100%) patients. There were 23 (44.2%) women and 29 (55.8%) men, aged 54 to 84 years with a mean age of 69.8 years.

Ventricular septal rupture (n = 36; 69.2%) was the most frequently observed complication but papillary muscle rupture (n = 4; 7.7%) and tendinous chord rupture (n = 4; 7.7%) were the least frequent. Hypertension and hypercholesterolemia were the most common risk factors for coronary heart disease in the study group. An increased mortality rate was observed in patients who received pharmacological treatment compared to surgically treated patients (87.5% vs. 61.4%). The majority of patients had one risk factor for coronary heart disease (28; 53.8%).

1. In the study group, ventricular septal rupture and the cardiac free wall rupture were the most frequently observed mechanical complications of AMI. 2. Patients with AMI had numerous risk factors for coronary heart disease, of which hypertension and hypercholesterolemia were the most common. 3. Patients with mechanical complications of AMI had both higher mortality rates than survival and they were higher in the pharmacologically treated group.

Hamm C.W., Heeschen C., Falk E., Fox K.A. Ostre zespoły wieńcowe: patofizjologia, rozpoznanie i ocena ryzyka. W: Choroby serca i naczyń. T. 1. Red. A.J. Camm, T.F. Luscher, P.W. Serruys. Wyd. I polskie. Wyd. Medyczne Termedia. Poznań 2006, s. 349–383.
Prabhu S.D., Frangogiannis N.G. The Biological Basis for Cardiac Repair After Myocardial Infarction: From Inflammation to Fibrosis. Circ. Res. 2016; 119(1): 91–112, doi 10.1161/CIRCRESAHA.116.303577.
Talman V., Ruskoaho H. Cardiac fibrosis in myocardial infarction—from repair and remodeling to regeneration. Cell Tissue Res. 2016; 365(3): 563–581, doi: 10.1007/s00441-016-2431-9.
Lindsey M.L., Hall M.E., Harmancey R., Ma Y. Adapting extracellular matrix proteomics for clinical studies on cardiac remodeling post-myocardial infarction. Clin. Proteomics 2016; 13: 19, doi 10.1186/s12014-016-9120-2.
Cinq-Mars A., Voisine P., Dagenais F., Charbonneau E., Jacques F., Kalavrouziotis D., Perron J., Mohammadi S., Dubois M., Le Ven F., Poirier P. et al. Risk factors of mortality after surgical correction of ventricular septal defect following myocardial infarction: Retrospective analysis and review of the literature. Int. J. Cardiol. 2016; 206: 27–36, doi: 10.1016/j.ijcard.2015.12.011.
Zhang Z.P., Su X., Liu C.W. Song D., Peng J., Wu M.X., Yang Y.C., Liu B., Xu C.Y., Wang F. Use of intra-aortic balloon pump support for oozing-type cardiac rupture after acute myocardial infarction. Am. J. Emerg. Med. 2016; 34(1): 120.e1–120.e3, doi: 10.1016/j.ajem.2015.05.054.
Reddy Y.W., Al-Hijji M., Best P.J., Sinak L.J., Suri R.M., Ijioma N.N., Aberle S.J., Goyal D.G., Singh M. Diagnosis of Free-Wall Rupture by Left Ventricular Angiogram After Inferior ST-Segment–Elevation Myocardial Infarction. Circulation 2015; 132(5): e31–33, 10.1161/CIRCULATIONAHA.115.015951.
Noorani A., Burt C., Nashef S.A. Post-infarction biventricular free wall rupture with extracardiac shunt presenting as ventricular septal rupture. Interact. Cardiovasc. Thorac. Surg. 2013; 17(2): 419–420, doi: 10.1093/icvts/ivt215.
Gao X.M., White D.A., Dart A.M., Du X.J. Post-infarct cardiac rupture: recent insights on pathogenesis and therapeutic interventions. Pharmacol. Ther. 2012; 134(2): 156–179, doi: 10.1016/j.pharmthera.2011.12.010.
Ari H., Melek M., Ari S., Doğanay K., Coşar Öztaş S. Percutaneous closure of post-myocardial infarction ventricular septal rupture in patients with ventricular septal rupture and apical thrombus: first case in literature. Int. J. Cardiol. 2015; 182: 487–490, doi: 10.1016/j.ijcard.2014.12.164.
Trivedi K.R., Aldebert P., Riberi A., Mancini J., Levy G., Macia J.C., Quilicci J., Habib G., Fraisse A. Sequential management of post-myocardial infarction ventricular septal defects. Arch. Cardiovasc. Dis. 2015; 108(5): 321–330, doi: 10.1016/j.acvd.2015.01.005.
Mangovski L., Kozlik-Feldmann R., Perić M., Jovović L., Farkić M., Dekić D. Challenges in treatment of postinfarction ventricular septal defect and heart failure. Vojnosanit. Pregl. 2015; 72(1): 68–71.
Dal-Bianco J.P., Aikawa E., Bischoff J., Guerrero J.L., Hjortnaes J., Beaudoin J., Szymanski C., Bartko P.E., Seybolt M.M., Handschumacher M.D., Sullivan S. Myocardial Infarction Alters Adaptation of the Tethered Mitral Valve. J. Am. Coll. Cardiol. 2016; 67(3): 275–287, doi: 10.1016/j.jacc.2015.10.092.
Cherian P.S., Clarke A.J., Burstow D.J. Unusual Case of Acute Posteromedial Papillary Muscle Rupture After Acute Anterior Myocardial Infarction. Heart Lung Circ. 2014; 23(1): e16–19, doi: 10.1016/j.hlc.2013.07.005.
Agarwal C., Goel S., Jacobi A., Love B., Sanz J. CT imaging of post-myocardial infarction ventricular septal defect with a contained rupture/pseudoaneurysm. Indian Heart J. 2015; 67 Suppl. 3: S107–109, doi: 10.1016/j.ihj.2015.07.035.
Noguchi K., Yamaguchi A., Naito K., Yuri K., Adachi H. Short-term and long-term outcomes of postinfarction ventricular septal perforation. Gen. Thorac. Cardiovasc. Surg. 2012; 60(5): 261–267, doi: 10.1007/s11748-011-0882-1.
Ashfaq A., Sharif H. Mechanical complications following acute myocardial infarction. J. Pak. Med. Assoc. 2012; 62(8): 861–865.
Tang L., Fang Z., Hu X., Tang J., Shen X., Lu X., Zhao Y., Li J., Zhou S. Non-surgical repair of ventricular septal rupture after acute myocardial infarction. Int. J. Cardiol. 2015; 185: 328–332, doi: 10.1016/j.ijcard.2015.03.144.
Yalcinkaya A., Lafci G., Diken A., Aksoy E., Cicek O.F., Lafci A., Korkmaz K., Cagli K. Early Mortality and Long-term Survival after Repair of Post-infarction Ventricular Septal Rupture: An Institutional Report of Experience. Heart Lung Circ. 2016; 25(4): 384–391, doi: 10.1016/j.hlc.2015.08.016.
Huang S.M., Huang S.C., Wang C.H., Wu I.H., Chi N.H., Yu H.Y., Hsu R.B., Chang C.I., Wang S.S., Chen Y.S. Risk factors and outcome analysis after surgical management of ventricular septal rupture complicating acute myocardial infarction: a retrospective analysis. J. Cardiothorac. Surg. 2015; 10: 66, doi: 10.1186/s13019-015-0265-2.
Serpytis P., Karvelyte N., Serpytis R., Kalinauskas G., Rucinskas K., Samalavicius R., Ivaska J., Glaveckaite S., Berukstis E., Tubaro M., Alpert J.S., Laucevičius A. Post-Infarction Ventricular Septal Defect: Risk Factors and Early Outcomes. Hellenic J. Cardiol. 2015; 56(1): 66–71.
Ivanov I., Lovrenski A., Dejanović J., Petrović M., Jung R., Raffay V. Double heart rupture after acute myocardial infarction: a case report. Vojnosanit. Pregl. 2014; 71(12): 1151–1154.
Wożakowska-Kapłon B., Dąbkowski P., Pietrzyk E., Sadowski J. Ventricular septum and free wall rupture in a 56-year-old male with myocardial infarction. A case report with follow-up of 7 years. Kardiol. Pol. 2009; 67(6): 651–655.
Nozoe M., Sakamoto T., Taguchi E., Miyamoto S., Fukunaga T., Nakao K. Clinical manifestation of early phase left ventricular rupture complicating acute myocardial infarction in the primary PCI era. J. Cardiol. 2014; 63(1): 14–18, doi: 10.1016/j.jjcc.2013.06.012.
Pang P.Y., Sin Y.K., Lim C.H., Tan T.E., Lim S.L., Chao V.T., Su J.W., Chua Y.L. Outcome and survival analysis of surgical repair of post-infarction ventricular septal rupture. J. Cardiothorac. Surg. 2013; 8: 44, doi: 10.1186/1749-8090-8-44.
Reeder G.S. Identification and Treatment of Complications of Myocardial Infarction. Mayo Clin. Proc. 1995; 70(9): 880–884.
Heiberg J., Hjortdal V.E., Nielsen-Kudsk J.E. Long‐Term Outcome after Transcatheter Closure of Postinfarction Ventricular Septal Rupture. J. Interv. Cardiol. 2014; 27(5): 509–515, doi: 10.1111/joic.12146.
Sathananthan J., Ruygrok P. Evolution in the Management of Postinfarct Ventricular Septal Defects From Surgical to Percutaneous Approach: A Single-Center Experience. J. Invasive Cardiol. 2013; 25(7): 339–343.
Radosavljević-Radovanović M., Radovanović N., Arandjelović A., Mitrović P., Ušćumlić A., Stanković G. Urgent Hybrid Approach in Treatment of the Acute Myocardial Infarction Complicated by the Ventricular Septal Rupture. Srp. Arh. Celok. Lek. 2014; 142(3–4): 226–228.
Shreetal R.N., Sajeer K., Sandeep R., Rajesh G.N., Haridasan V., Sadanadan R., Kuriakose K.M., Narayanan Krishnan M. Double ventricular rupture after acute myocardial infarction: A rare case report. Indian Heart J. 2015; 67 Suppl. 3: S21–23, doi: 10.1016/j.ihj.2015.06.020.
Leitman M., Tsatskin L., Hendler A., Blatt A., Peleg E., Vered Z. Cardiac Rupture: New Features of the Old Disease. Cardiology 2016; 133(4): 257–261, doi: 10.1159/000442815.