Low incidence of mechanical complications in patients with AMI

Abstract Background Despite early and currently effective epicardial coronary recanalization in patients with acute myocardial infarction (AMI), the mortality rate after mechanical complication (MC) remains high. Despite its impact on the prognosis of patients with AMI, up-to-date real life data regarding to epidemiology and management of patients with MC following AMI still scarce and most studies exclude patients with MC. Methods Using the National Inpatient Sample database from 2015 to 2018 to identify patients with AMI, we aimed to determine the epidemiology, predictors and outcomes of patients with MC following AMI in the US. Results We identified 2,427,315 patients with AMI; 2345 (0.1 %) developed MC. Regarding subtypes, 960 (40.9 %) had ventricular septal rupture (VSR), 540 (23.0 %) papillary muscle rupture (PMR), 530 (22.6 %) pseudoaneurysm, and 315 (13.4 %) free wall rupture FWR). Mortality was 12 times higher (OR: 11.663, CI: 10.582–12.855,p< 0.001) in patients with MC compared to patients without MC (49.7% vs. 4.6 %,p< 0.001) and all subtypes of MC showed a significant increase in mortality. Conclusions Nowadays, the incidence of MC after an AMI is lower than in the past, nonetheless the in-hospital mortality rate remains very high. It tends to occur more in older patients and in those with fewer comorbidities. The subtype with the highest frequency and highest mortality rates was VSR.