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Mechanical Complications of Acute Myocardial Infarction: Clinical Characteristics and Mortality Trends
Session:
SESSÃO DE POSTERS 08 - DOENÇAS CARDIOVASCULARES - PROGNÓSTICO NO SCA
Speaker:
Mariana Carvalho
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Cartazes
FP Number:
---
Authors:
Mariana Ferreira Carvalho; Carolina Gonçalves; Adriana Vazão; André Martins; Joana Pereira; Mónica Amado; Jorge Guardado; Hélia Martins; Em Nome Dos Investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p style="text-align:start"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="color:black">Introduction</span></strong><strong><span style="color:black">:</span></strong><strong> </strong><span style="color:black">Mechanical complications following acute myocardial infarction (AMI) remain a critical concern despite advances in reperfusion therapies. These events, though less frequent with improved reperfusion, still carry significant mortality. This study aimed to evaluate temporal trends in incidence and mortality of mechanical complications post-AMI in Portugal and identify key prognostic factors, emphasizing the clinical impact of these findings.</span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="color:black">Methods:</span></strong> <span style="color:black">A retrospective study using data from the Portuguese Registry of Acute Coronary Syndromes (ProACS) (2002-2022) on STEMI patients ≥18 years presenting within 12 hours and undergoing reperfusion. Survival analysis included Kaplan-Meier estimates for survival probabilities and Cox proportional hazards models to identify independent predictors of mortality. Temporal mortality trends were assessed with segmented regression to evaluate statistical significance over four defined periods.</span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="color:black">Results:</span></strong> <span style="color:black">Of 5,269 STEMI patients, 26 (0.5%) had complications: acute mitral regurgitation (38.5%), ventricular free wall rupture (34.6%), and ventricular septal rupture (26.9%). In-hospital mortality was significantly higher in these patients (p<0.001). Mortality declined from 0.8% (2011-2013) to 0.5% (2020-2023; p=0.005). One-year survival was 45% for patients with complications versus 90% for those without. Key predictors of mortality included advanced age (HR=1.04, p<0.001), diabetes (HR=1.49, p=0.017), prior heart failure (HR=1.97, p=0.026), vascular disease (HR=2.86, p<0.001), and malignancy (HR=2.55, p<0.001). Dyslipidemia showed a protective effect (HR=0.64, p=0.005), likely reflecting statin therapy benefits. Kaplan-Meier analysis revealed 62% of deaths occurred within 30 days. Free wall rupture had the worst prognosis (25% one-year survival), followed by septal rupture (40%) and mitral regurgitation (50%). Temporal trends showed patients receiving reperfusion within 6 hours experienced significantly lower mortality than those treated later (p<0.01).</span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="color:black">Conclusions:</span></strong> <span style="color:black">Mechanical complications of STEMI remain rare but associated with high mortality, particularly within the first 30 days post-event. This analysis shows that early reperfusion (<6 hours) significantly reduces mortality, emphasizing the need for rapid intervention. Identifying high-risk groups, such as patients with advanced age, prior heart failure, or vascular disease, allows physicians to tailor management strategies. </span></span></span></span></p>
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