Mechanical complications in ST-elevation myocardial infarction: The impact of pre-hospital delay

Area of Science:

• Cardiology
• Acute Myocardial Infarction Research
• Medical Complications

Background:

• Mechanical complications (MC) such as free wall rupture (FWR), papillary muscle rupture (PMR), and ventricular septal rupture (VSR) are rare but severe consequences of ST-elevation acute myocardial infarction (STEMI).
• The impact of pre-hospital delay on the incidence of these mechanical complications in STEMI patients is not well-established.

Purpose of the Study:

• To investigate the relationship between pre-hospital delay and the incidence of mechanical complications in patients with STEMI.
• To identify factors associated with the occurrence of mechanical complications following STEMI.

Main Methods:

• Analysis of data from the MODIF registry.
• Patients were stratified into four groups based on pre-hospital delay: 0-12 hours, 12-24 hours, 24-36 hours, and 36-48 hours.
• Multivariate analysis was performed to identify independent predictors of MC.

Main Results:

• Out of 6185 analyzed patients, 83 (1.34%) experienced mechanical complications.
• The incidence of MC significantly increased with pre-hospital delay, rising to 5.07% in the 36-48 hour group (p < 0.001).
• Independent risk factors for MC included older age, female sex, COVID-19 infection, absence of dyslipidemia, initial TIMI flow 0-1, prolonged pre-hospital delay (36-48 hours), and lack of percutaneous coronary intervention (PCI).

Conclusions:

• The probability of developing mechanical complications in STEMI patients escalates with longer pre-hospital delays.
• Mechanical complications of STEMI are associated with a high in-hospital mortality rate and a very poor prognosis.