TY  - BOOK
AU  - Afonso, Luis
AU  - Glazier, James J
AU  - Pahuja, Mohit
TI  - Rupture of Papillary Muscle and Chordae Tendinae Complicating STEMI: A Call for Action
SN  - 1058-2916
PY  - 2021///
KW  - *ST Elevation Myocardial Infarction
KW  - Aged
KW  - Female
KW  - Hospital Mortality
KW  - Humans
KW  - Male
KW  - Papillary Muscles
KW  - Retrospective Studies
KW  - Shock, Cardiogenic/et [Etiology]
KW  - ST Elevation Myocardial Infarction/co [Complications]
KW  - ST Elevation Myocardial Infarction/su [Surgery]
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available online from MWHC library: 2000 - present, Available in print through MWHC library: 1999 - 2003
N2  - 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
UR  - https://dx.doi.org/10.1097/MAT.0000000000001299
ER  -