Author + information
- Received April 19, 2018
- Revision received June 8, 2018
- Accepted June 11, 2018
- Published online August 20, 2018.
- Elena Puerto, MDa,
- Ana Viana-Tejedor, MD, PhDb,∗,
- Manuel Martínez-Sellés, MD, PhDc,
- Laura Domínguez-Pérez, MDa,
- Guillermo Moreno, RNa,
- Roberto Martín-Asenjo, MDa and
- Héctor Bueno, MD, PhDa,d,e,∗∗ (, )@CNIC_CARDIO@CIBER_CV@cardioH12O
- aCardiology Department, Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, Madrid, Spain
- bCardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
- cCardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense de Madrid, Madrid, Spain
- dCentro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- eFacultad de Medicina, Universidad Complutense de Madrid, Spain
- ↵∗Address for correspondence:
Dr. Héctor Bueno, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Cardiology Department, Hospital Universitario 12 de Octubre, Melchor Fernandez Almagro, 3, 28029-Madrid, Spain.
Background Reperfusion therapy led to an important decline in mortality after ST-segment elevation myocardial infarction (STEMI). Because the rate of cardiogenic shock has not changed dramatically, the authors speculated that a reduction in the incidence or fatality rate of mechanical complications (MCs), the second cause of death in these patients, could explain this decrease.
Objectives This study sought to assess time trends in the incidence, management, and fatality rates of MC, and its influence on short-term mortality in old patients with STEMI.
Methods Trends in the incidence and outcomes of MC between 1988 and 2008 were analyzed by Mantel-Haenszel linear association test in 1,393 consecutive patients ≥75 years of age with first STEMI.
Results Overall in-hospital mortality decreased from 34.3% to 13.4% (relative risk reduction, 61%; p < 0.001). Although the absolute mortality due to MC decreased from 9.6% to 3.3% (p < 0.001), the proportion of deaths due to MC among all deaths did not change (28.1% to 24.5%; p = 0.53). The incidence of MC decreased from 11.1% to 4.3% (relative risk reduction 61%) with no change in their hospital fatality rate over time (from 87.1% to 82.4%; p = 0.66). The proportion of patients undergoing surgical repair decreased from 45.2% to 17.6% (p = 0.04), with no differences in post-operative survival (from 28.6% to 33.3%; p = 0.74).
Conclusions Although the incidence of MC has decreased substantially since the initiation of reperfusion therapy in elderly STEMI patients, this reduction was proportional to other causes of death and was not accompanied by an improvement in fatality rates, with or without surgery. MCs are less frequent but remain catastrophic complications of STEMI in these patients.
↵∗ Drs. Viana-Tejedor and Bueno were affiliated with the Cardiology Department, Hospital General Universitario Gregorio Marañón, when the registry was done.
Dr. Bueno has received research funding from the Instituto de Salud Carlos III (PIE16/00021, PI17/01799), AstraZeneca, Bristol-Myers Squibb, Janssen, and Novartis; consulting fees from AstraZeneca, Bayer, Bristol-Myers Squibb-Pfizer, and Novartis; and speaking fees or support for attending scientific meetings from AstraZeneca, Bayer, Bristol-Myers Squibb-Pfizer, Ferrer, Novartis, and Medscape/the heart.org. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 19, 2018.
- Revision received June 8, 2018.
- Accepted June 11, 2018.
- 2018 American College of Cardiology Foundation