Mechanical Complications After Acute Myocardial Infarction: A Shock-Stage and Timing-Based Management Framework

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Interventional Cardiology

Background:

• Mechanical complications following acute myocardial infarction (MI), including ventricular septal rupture (VSR), free-wall rupture (FWR), and papillary muscle rupture (PMR), are infrequent but highly lethal.
• Contemporary mortality is primarily linked to cardiogenic shock and treatment delays.

Purpose of the Study:

• To synthesize current surgical and transcatheter evidence for mechanical MI complications.
• To propose a unified, physiology-centered framework for managing these emergencies.
• To introduce the STABLE checklist for consistent triage and timing of interventions.

Main Methods:

• Review of current surgical and transcatheter evidence.
• Development of a physiology-centered management framework.
• Introduction of the STABLE bedside checklist for decision support.

Main Results:

• Despite consensus on urgent imaging and mechanical support, transatlantic differences in VSR intervention timing persist.
• The proposed framework integrates shock staging, anatomical factors, and mechanical support response.
• The STABLE checklist aims to standardize daily triage and align intervention timing with hemodynamic stabilization.

Conclusions:

• Mechanical complications of MI remain critical emergencies requiring prompt and coordinated care.
• A unified, physiology-centered approach, supported by tools like the STABLE checklist, can improve management and outcomes.
• Standardized decision-making is crucial to overcome center-specific habits and optimize patient care.