Temporal Trends and Outcomes of Mechanical Complications in Patients With Acute Myocardial Infarction.

The aim of this study was to examine the temporal trends and outcomes of mechanical complications after myocardial infarction in the contemporary era. Data regarding temporal trends and outcomes of mechanical complications after ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) are limited in the contemporary era. The National Inpatient Sample database (2003 to September 2015) was queried to identify all STEMI and NSTEMI hospitalizations. Temporal trends and outcomes of mechanical complications after STEMI and NSTEMI, including papillary muscle rupture, ventricular septal defect, and free wall rupture, were described. The analysis included 3,951,861 STEMI and 5,114,270 NSTEMI hospitalizations. Mechanical complications occurred in 10,726 of STEMI hospitalizations (0.27%) and 3,041 of NSTEMI hospitalizations (0.06%), with no changes in trends (p = 0.13 and p = 0.83, respectively). The rates of in-hospital mortality in patients with mechanical complications were 42.4% after STEMI and 18.0% after NSTEMI, with no significant trend changes (p = 0.62 and p = 0.12, respectively). After multivariate adjustment, patients who had mechanical complications after myocardial infarction had higher in-hospital mortality, cardiogenic shock, acute kidney injury, hemodialysis, and respiratory complications compared with those without mechanical complications. Predictors of lower mortality in patients with mechanical complications who developed cardiogenic shock included surgical repair in the STEMI and NSTEMI cohorts and percutaneous coronary intervention in the STEMI cohort. Contemporary data from a large national database show that the rates of mechanical complications are low in patients presenting with STEMI and NSTEMI. Post-myocardial infarction mechanical complications continue to be associated with high mortality rates, which did not improve during the study period.

Elbadawi A ，Elgendy IY ，Mahmoud K ，Barakat AF ，Mentias A ，Mohamed AH ，Ogunbayo GO ，Megaly M ，Saad M ，Omer MA ，Paniagua D ，Abbott JD ，Jneid H ... -  《-》

Outcomes of Acute Myocardial Infarction in Patients with Rheumatoid Arthritis.

There is a paucity of data on the outcomes of acute myocardial infarction in patients with rheumatoid arthritis in the contemporary era. We queried the National Inpatient Sample database (2002-2016) for hospitalizations with acute myocardial infarction. We described the trends and outcomes of acute myocardial infarction-rheumatoid arthritis compared with acute myocardial infarction-no rheumatoid arthritis. The analysis included 9,359,546 hospitalizations with acute myocardial infarction, of whom 123,783 (1.3%) had rheumatoid arthritis. There was an increase in the number of hospitalizations with acute myocardial infarction-rheumatoid arthritis (Ptrend < .001). There was an observed downtrend in mortality rates for acute myocardial infarction-rheumatoid arthritis (5.8% in 2002 vs 5.2% in 2016, Ptrend = .01) corresponding to an increase in the utilization of percutaneous coronary intervention (Ptrend < .001). In the overall cohort of acute myocardial infarction, rheumatoid arthritis was independently associated with lower rate of in-hospital mortality (adjusted odds ratio 0.90; 95% confidence interval, 0.81-0.99, P = .03). Compared with ST-elevation myocardial infarction (STEMI)-no rheumatoid arthritis, STEMI-rheumatoid arthritis was associated with lower in-hospital mortality and cardiac arrest, while it was associated with higher discharges to nursing facilities. No difference in mortality was observed among non-ST-elevation myocardial infarction (NSTEMI)-rheumatoid arthritis and NSTEMI-no rheumatoid arthritis, while NSTEMI-rheumatoid arthritis was associated with lower cardiac arrest, cardiogenic shock, and hemodialysis, at the expense of higher bleeding events and discharges to nursing facilities. In this nationwide analysis, we found an increase in hospitalizations for acute myocardial infarction-rheumatoid arthritis. Among patients with acute myocardial infarction, rheumatoid arthritis was independently associated with lower in-hospital mortality, particularly in cases of STEMI.

Elbadawi A ，Ahmed HMA ，Elgendy IY ，Omer MA ，Ogunbayo GO ，Abohamad S ，Paniagua D ，Jneid H ... -  《-》

National Trends and Outcomes of Acute Myocardial Infarction After Transcatheter Aortic Valve Replacement.

Prior studies have reported decreased use of an invasive approach for acute myocardial infarction (AMI) in patients undergoing transcatheter aortic valve replacement (TAVR). The aim of this study was to determine whether prior TAVR affects the use of subsequent coronary revascularization and outcomes of AMI in a contemporary national data set. Consecutive TAVR patients from 2016 to 2022 were identified from the U.S. Vizient Clinical Data Base who were hospitalized after the index TAVR hospitalization with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI). Patients with STEMI or NSTEMI with or without prior TAVR from the same time period were compared for the use of coronary angiography, revascularization, and in-hospital outcomes. Propensity score matching was used to account for imbalances in patient characteristics. Among 206,229 patients who underwent TAVR, the incidence of STEMI was 25 events per 100,000 person-years of follow-up, and that of NSTEMI was 229 events per 100,000 person-years. After propensity matching, the use of coronary revascularization was similar in the prior TAVR and no TAVR cohorts in both the STEMI (65.3% vs 63.9%; P = 0.81) and NSTEMI (41.4% vs 41.7%; P = 0.88) subgroups. Compared with patients without prior TAVR, in-hospital mortality was higher in the prior TAVR cohort in patients with STEMI (27.1% vs 16.7%; P = 0.03) and lower in those with NSTEMI (5.8% vs 8.2%; P = 0.02). In this large, national retrospective study, AMI events after TAVR were infrequent. There were no differences in the use of coronary revascularization for STEMI or NSTEMI in TAVR patients compared with the non-TAVR population. In-hospital mortality for STEMI is higher in TAVR patients compared with those without prior TAVR.

Gupta T ，Zimmer J ，Lahoud RN ，Murphy HR ，Harris AH ，Kolte D ，Hirashima F ，Dauerman HL ... -  《-》

Current characteristics and management of ST elevation and non-ST elevation myocardial infarction in the Tokyo metropolitan area: from the Tokyo CCU network registered cohort.

Miyachi H ，Takagi A ，Miyauchi K ，Yamasaki M ，Tanaka H ，Yoshikawa M ，Saji M ，Suzuki M ，Yamamoto T ，Shimizu W ，Nagao K ，Takayama M ... -  《-》

Short- and Long-Term Clinical Outcomes for Patients With Takotsubo Syndrome and Patients With Myocardial Infarction: A Report From the Swedish Coronary Angiography and Angioplasty Registry.

Redfors B ，Jha S ，Thorleifsson S ，Jernberg T ，Angerås O ，Frobert O ，Petursson P ，Tornvall P ，Sarno G ，Ekenbäck C ，Ravn-Fisher A ，Y-Hassan S ，Lyon AR ，James S ，Erlinge D ，Omerovic E ... -  《Journal of the American Heart Association》