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Primary Outcome Assessment in a Pig Model of Acute Myocardial Infarction
Published on: October 14, 2016
Outcomes and Hospital Utilization in Patients With Papillary Muscle Rupture Associated With Acute Myocardial
Bhaskar Bhardwaj1, Gurusukhmandeep Sidhu2, Sudarshan Balla3
1University of Missouri School of Medicine, Columbia, Missouri.
Abstract:
Papillary muscles rupture (PMR) is a rare complication of acute myocardial infarction (MI) that can lead to severe hemodynamic compromise, acute heart failure, and death. This study was designed to assess demographics, outcomes, and hospital utilization trends in the management of PMR associated with acute MI. Data were derived from the National Inpatient Sample for the years 2005 to 2014. ICD-9 codes 410.0 to 410.9 were used to identify patients with acute MI. ICD-9 code 429.6 was used to identify patients with PMR. ICD-9 procedures codes 35.23, 35.24, and 35.12 were used to identify patients who underwent mitral valve replacement (MVR) or repair. Of the 3,244,799 admissions, 932 were complicated by PMR (incidence of 0.029%). The majority of patients with PMR were ≥65 years old (60.1%) and male (60.4%). Of those with PMR, 57.5% underwent MVR. Compared to patients without PMR, those with PMR had a significantly higher in-hospital mortality rate (5.3 vs 36.3%, p <0.001), cost of hospitalization ($20,205 vs $74,383, p <0.001) and length of hospital stay (4.67 ± 02 vs 11.2 ± 0.80 days, p <0.001). Predictors of in-hospital mortality in PMR patients were age, inferior wall acute MI, and cardiac arrest. Predictors of MVR in PMR patients were age, female gender, concomitant coronary artery bypass grafting, mechanical circulatory support, longer length of stay, and admission to a large hospital. In conclusion, patients with PMR associated with acute MI have higher risk of in-hospital mortality, greater cost of hospitalization and longer length of stay than patients acute MI without PMR.
Insights
Papillary muscle rupture (PMR) following acute myocardial infarction (MI) significantly increases in-hospital mortality, hospitalization costs, and length of stay. Early identification and management of PMR are crucial for improving patient outcomes in acute MI cases.
Area of Science:
- Cardiology
- Cardiac Surgery
- Health Services Research
Background:
- Papillary muscle rupture (PMR) is a rare but life-threatening complication of acute myocardial infarction (MI).
- PMR can lead to severe hemodynamic compromise, acute heart failure, and increased mortality.
- Understanding the trends in PMR management and outcomes is essential for improving patient care.
Purpose of the Study:
- To assess the demographics, hospital utilization, and outcomes of patients experiencing PMR following acute MI.
- To identify predictors of in-hospital mortality and mitral valve repair/replacement (MVR) in PMR patients.
- To analyze trends in PMR management over a 10-year period.
Main Methods:
- Retrospective analysis of the National Inpatient Sample (NIS) database from 2005 to 2014.
- Identification of acute MI using ICD-9 codes 410.0-410.9 and PMR using ICD-9 code 429.6.
- Analysis of mitral valve replacement or repair (MVR) using ICD-9 procedure codes 35.23, 35.24, and 35.12.
Main Results:
- The incidence of PMR among acute MI admissions was 0.029% (932 cases out of 3,244,799).
- PMR patients were predominantly older (≥65 years, 60.1%) and male (60.4%).
- In-hospital mortality was significantly higher in PMR patients (36.3%) compared to non-PMR patients (5.3%).
- PMR patients experienced longer hospital stays (11.2 vs 4.67 days) and higher costs ($74,383 vs $20,205).
- Predictors of mortality included advanced age, inferior wall MI, and cardiac arrest.
- Predictors for MVR included age, female gender, concurrent CABG, mechanical support, longer stay, and large hospital admission.
Conclusions:
- PMR in the context of acute MI is associated with substantially worse in-hospital outcomes, including higher mortality, increased hospitalization costs, and prolonged hospital stays.
- Age, inferior wall MI, and cardiac arrest are key predictors of mortality in PMR patients.
- Surgical intervention (MVR) is frequently employed, with specific demographic and clinical factors influencing its utilization.
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