Mechanical Complications After Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction (from APEX-AMI)

John K. French, Anne S. Hellkamp, Paul W. Armstrong, Eric Cohen, Neil S. Kleiman, Christopher M. O'Connor, David R. Holmes, Judith S. Hochman, Christopher B. Granger, Kenneth W. Mahaffey

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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.

Original languageEnglish (US)
Pages (from-to)59-63
Number of pages5
JournalAmerican Journal of Cardiology
Volume105
Issue number1
DOIs
StatePublished - Jan 1 2010

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

French, J. K., Hellkamp, A. S., Armstrong, P. W., Cohen, E., Kleiman, N. S., O'Connor, C. M., Holmes, D. R., Hochman, J. S., Granger, C. B., & Mahaffey, K. W. (2010). Mechanical Complications After Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction (from APEX-AMI). American Journal of Cardiology, 105(1), 59-63. https://doi.org/10.1016/j.amjcard.2009.08.653