Document Detail

Mechanical complications after percutaneous coronary intervention in ST-elevation myocardial infarction (from APEX-AMI).
MedLine Citation:
PMID:  20102891     Owner:  NLM     Status:  MEDLINE    
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.
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
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  The American journal of cardiology     Volume:  105     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-27     Completed Date:  2010-03-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  59-63     Citation Subset:  AIM; IM    
Cardiology Department, University of New South Wales, Sydney, New South Wales, Australia.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects*,  instrumentation*
Equipment Failure
Follow-Up Studies
Heart Injuries / etiology*,  mortality
Middle Aged
Myocardial Infarction / physiopathology,  therapy*
Retrospective Studies
Risk Factors
Survival Rate / trends

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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