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.
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Article info
Publication history
Published online: January 06, 2020
Received in revised form:
December 17,
2019
Received:
September 16,
2019
Footnotes
Funding Sources: None.
Declarations of Interest: None.
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