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

Published:January 06, 2020DOI:https://doi.org/10.1016/j.amjcard.2019.12.051
      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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      References

        • Kutty RS
        • Jones N
        • Moorjani N
        Mechanical complications of acute myocardial infarction.
        Cardiol Clin. 2013; 31: 519-531
      1. Laham RJ, Simons M, Suri RM. Mechanical Complications of Acute Myocardial Infarction: Up to Date, www.uptodate.com, Accessed May 17, 2019.

        • Nishimura RA
        • Schaff HV
        • Shub C
        • Gersh BJ
        • Edwards WD
        • Tajik AJ
        Papillary muscle rupture complicating acute myocardial infarction: analysis of 17 patients.
        Am J Cardiol. 1983; 51: 373-377
        • Tcheng JE
        • Jackmann Jr., JD
        • Nelson CL
        • Gardner LH
        • Smith LR
        • Rankin JS
        • Califf RM
        • Stack RS
        Outcome of patients sustaining acute ischemic mitral regurgitation during myocardial infarction.
        Ann Intern Med. 1992; 117: 18-24
        • Wei JY
        • Hutchins GM
        • Bulkley BH
        Papillary muscle rupture in fatal acute myocardial infarction: a potentially treatable form of cardiogenic shock.
        Ann Intern Med. 1979; 90: 149-152
        • Thompson CR
        • Buller CE
        • Sleeper LA
        • Antonelli TA
        • Webb JG
        • Jaber WA
        • Abel JG
        • Hockman JS
        Cardiogenic shock due to acute severe mitral regurgitation complicating acute myocardial infarction: a report from the SHOCK Trial Registry. Should we use emergently revascularize occluded coronaries in cardiogenic shock?.
        J Am Coll Cardiol. 2000; 36: 1104-1109
        • Yeh RW
        • Sidney S
        • Chandra M
        • Sorel M
        • Selby JV
        • Go AS
        Population trends in the incidence and outcomes of acute myocardial infarction.
        N Engl J Med. 2010; 362: 2155-2165
        • Puerto E
        • Viana-Tejedor A
        • Martinez-Selles M
        • Dominguez-Perez L
        • Moreno G
        • Martin Asenio R
        • Bueno H
        Temporal trends in mechanical complication of acute myocardial infarction in the elderly.
        J Am Coll Cardiol. 2018; 72: 959-966
        • Figueras J
        • Cortadellas J
        • Calvo F
        • Soler-Soler J
        Relevance of delayed hospital admission on development of cardiac rupture during acute myocardial infarction: study in 225 patients with free wall, septal or papillary muscle rupture.
        J Am Coll Cardiol. 1998; 32: 135-139
        • Nishimura RA
        • Otto CM
        • Bonow RO
        • Carabello BA
        • Erwin 3, JP
        • Guyton RA
        • O'Gara PT
        • Ruiz CE
        • Skubas NJ
        • Sarajj P
        • Sundt 3, TM
        • Thomas JD
        Guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        Circulation. 2014; 129: e521-e643
      2. AHRQ. Anon Overiew of the National (Nationwide) Inpatient Sample (NIS) Available at: http://wwwhcup-usahrqgov/nisoverviewjsp. Accessed August 31, 2018.

      3. Barrett MWE, Whalen D. Summary 2007 HCUP Nationwide Inpatient Sample (NIS) Comparison Report. HCUP Method Series Report # 2010-03. Online September 9, 2010. U.S Agency for Healthcare Research and Quality, https://www.hcup-us.ahrq.gov/reports/methods/2010_03.pdf.

        • Thompson NR
        • Fan Y
        • Dalton Jehi L
        • Rosenbaum BP
        • Vadera S
        • Griffith SD
        A new Elixhauser-based comorbidity summary measure to predict in-hospital mortality.
        Med Care. 2015; 53: 374-379
        • Quan H
        • Sundararajan V
        • Halfon P
        • Fong A
        • Burnand B
        • Luthi JC
        • Saunders LD
        • Beck CA
        • Feasby TE
        • Ghali WA
        Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.
        Med Care. 2005; 43: 1130-1139
        • GUSTO Investigators
        An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction.
        N Engl J Med. 1993; 329: 673-682
        • French JK
        • Hellkamp AS
        • Armstrong PW
        • Cohen E
        • Kleiman NS
        • O'Connor CM
        • Holmes DR
        • Hockman JS
        • Granger CB
        • Mahaffey KW
        Mechanical complications after percutaneous coronary intervention in ST-elevation myocardial infarction (from APEX-AMI).
        Am J Cardiol. 2010; 105: 59-63
        • Kinn JW
        • O'Neill WW
        • Benzuly KH
        • Jones DE
        • Grines CL
        Primary angioplasty reduces risk of myocardial rupture compared to thrombolysis for acute myocardial infarction.
        Cathet Cardiovasc Diagn. 1997; 42: 151-157
        • Badheka AO
        • Patel NJ
        • Grover P
        • Singh V
        • Arora S
        • Chothani A
        • Mehta K
        • Deshmukh A
        • Savani GT
        • Patel A
        • Panaich SS
        • Shah N
        • Rathod A
        • Brown M
        • Mohamad T
        • Tamburrino FV
        • Kar S
        • Makkar R
        • O'Neill WW
        • Demarchena E
        • Schreiber T
        • Grines CL
        • Rihal CS
        • Cohen MG
        Impact of annual operator and intuitional volume on percutaneous coronary intervention outcomes: A 5-year United States experience (2005-2009).
        Circulation. 2014; 130: 1392-1406
        • Sanders RJ
        • Neuberger KT
        • Ravin A
        Rupture of papillary muscles: occurrence of rupture of the posterior muscle in posterior myocardial infarction.
        Dis Chest. 1957; 31: 316-323
        • Bouma W
        • Wijdh-den Hamer IJ
        • Koene BM
        • Kuijpers M
        • Naolour E
        • Erasmus ME
        • van der Horst IC
        • Gurman 3, JH
        • Gorman RC
        • Mariana MA
        Predictors of in-hospital mortality after mitral valve surgery for post-myocardial infarction post-myocardial infarction papillary muscle rupture.
        J Cardiothorac Surg. 2014 Oct 18; https://doi.org/10.1186/s13019-014-0171-z
        • Kishon Y
        • Oh JK
        • Schaff HV
        • Mullany CJ
        • Tajik AJ
        • Gersh BJ
        Mitral valve operation in postinfarction rupture of papillary muscle: immediate results and long-term follow-up of 22 patients.
        Mayo Clin Proc. 1992; 67: 1023-1030
        • Chevalier P
        • Burri H
        • Fahrat F
        • Cucherat M
        • Jegaden O
        • Obadia JF
        • Kirkorian G
        • Touboui P
        Perioperative outcome and long-term survival of surgery for acute post-infarction mitral regurgitation.
        Eur J Cardiothorac Surg. 2004; 26: 330-335
        • Russo A
        • Suri RM
        • Grigioni F
        • Roger VA
        • Oh JK
        • Mahoney DW
        • Schaff HV
        • Enriquez-Sarano M
        Clinical outcome after surgical correction of mitral regurgitation due to papillary muscle rupture.
        Circulation. 2008; 118: 1528-1534
        • Schroeter T
        • Lehmann S
        • Misfeld M
        • Borger M
        • Subramanian S
        • Mohr FW
        • Bakthiary F
        Clinical outcome afer mitral valve surgery due to ischemic papillary muscle rupture.
        Ann Thorac Surg. 2013; 95: 820-824
        • Tavakoli R
        • Weber A
        • Vogt P
        • Brunner HP
        • Pretre R
        • Turina M
        Surgical management of cacute mitral valve regurgitation due to post-infarction papillary muscle rupture.
        J Heart Valve Dis. 2002; 11: 20-25
        • Tepe NA
        • Edmunds Jr., LH
        Operation for acute postinfarction mitral insufficiency and cardiogenic shock.
        J Thorac Cardiovasc Surg. 1985; 89: 525-530
        • Rihal CS
        • Naidu SS
        • Givertz MM
        • Szeto WY
        • Burke JA
        • Kapur NK
        • Kern M
        • Garratt KN
        • Goldstein JA
        • Dimas V
        • Tu T
        2015 SCAI/ACC/HFSA/STS clinical expert consensus statement on the use of percutaneous mechanical circultory support devices in cardiovascular care: endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervecion; Affirmation of value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention.
        J Am Coll Cardiol. 2015; 65: e7-e26
        • Wolff R
        • Cohen G
        • Peterson C
        • Wong S
        • Hockman E
        • Lo J
        • Strauss BH
        • Cohen EA
        MitraClip for papillary muscle rupture in patient with cardiogenic shock.
        Can J Cardiol. 2014 Nov; 30: 1461.e13-4https://doi.org/10.1016/cjca.2014.07015
        • Feldman T
        • Foster E
        • Glower DD
        • Kar S
        • Rinaldi MJ
        • Fali PS
        • Smalling R
        • Siegel R
        • Rose GA
        • Engeron E
        Percutaneous repair or surgery for mitral regurgitation.
        N Engl J Med. 2011; 364: 1395-1406
        • Estevez-Loureiro R
        • Arzamendi D
        • Freixa X
        • Cardenal R
        • Carrasco-Chinchilla F
        • Semador-Frutos A
        • Pan M
        • Sabbate M
        • Diaz J
        • Hernandez JM
        • Serra A
        • Fernandez-Vazquez F
        • Spanish Working Group on MitraClip
        Percutaneous mitral valve repair for acute mitral regurgitation after an acute myocardial infarction.
        J Am Coll Cardiol. 2015; 66: 91-92