Researchers used the National Inpatient Sample database from 2003 to 2017 to investigate trends in mechanical complications such as ventricular septal defect/rupture (VSR), free wall rupture (FWR), and papillary muscle rupture (PMR) in ST-elevation myocardial infarction (STEMI), notably during the primary percutaneous coronary interventions (PPCI).
A cohort study was conducted with participants from the United States. The National Inpatient Sample (NIS) database was accessed, and STEMI patients receiving PPCI, fibrinolysis with PCI. The only fibrinolysis between 2003 and 2017 was identified using the International Classification of Disease 9th 10th revision codes (ICD-9 and ICD-10). Patients that developed PMR, FWR, or VSD after hospitalization were identified.
Overall, 2,034,153 STEMI patients were identified, among which 93.5% of patients received PPCI, 3.3% patients have undergone fibrinolysis with subsequent PCI, and 3.2 % patients had the only fibrinolysis. However, a decrease in the rate of all above mentioned mechanical complications was recorded in patients who received the various reperfusion strategies (PPCI, fibrinolysis with PCI, and only fibrinolysis), and a decreasing trend of p <0.05 was observed in the long term.
Furthermore, according to multivariable logistic regression models, there was no significant statistical difference in the incidence of mechanical complication across patients treated with various reperfusion methods. Moreover, the rates of overall mechanical complications after STEMI were low, even when fibrinolytic were used initially, and the rates of mechanical complications showed a downward temporal trend.
In patients managed with primary percutaneous coronary interventions (PPCI), the overall mechanical complication rate after undergoing ST-elevation myocardial infarction (STEMI) was recorded to be less and showed a downward trend. This was also the case when patients were treated with fibrinolytic as initial therapy.