Outcomes and Hospital Utilization in Patients With Papillary Muscle Rupture Associated With Acute Myocardial...

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.