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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Mechanical Complications After Acute Myocardial Infarction: Contemporary Management, Treatment Selection, and Outcomes in a 10-Year Regional Referral Network

  • Alberto Alén1,2
  • Andrés Álvarez-Gato1
  • Manuel Sánchez1
  • Francisco González-Urbistondo3
  • María Salgado4
  • Rut Álvarez-Velasco1,2
  • Miguel Ángel Rodríguez-Yago5
  • María Isabel Soto1
  • Jacobo Silva2,6,7
  • Pablo Avanzas1,2,7
  • Rebeca Lorca1,2,7
7 affiliations
  1. 1Cardiology, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
  2. 2Instituto de Investigación del Principado de Asturias (ISPA), 33011 Oviedo, Spain
  3. 3Cardiology, Hospital de Sierrallana, 39300 Torrelavega, Spain
  4. 4Cardiology, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
  5. 5Cardiac Surgery Critic Care Unit, Hospital Universitario Central de Asturias (HUCA), 33006 Oviedo, Spain
  6. 6Cardiac Surgery, Hospital Universitario Central de Asturias (HUCA), 33006 Oviedo, Spain
  7. 7Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain
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Abstract

Background: Mechanical complications (MCs) after acute myocardial infarction (AMI) are now uncommon but remain highly lethal, and contemporary data encompassing the full spectrum of rupture phenotypes are limited. Methods: We retrospectively identified all consecutive adults with post-AMI MCs managed at a tertiary regional referral center from 2015 to 2025. MCs included ventricular septal rupture (VSR), left ventricular free-wall rupture (LVFWR), contained rupture/pseudoaneurysm, and papillary muscle rupture (PMR). The primary endpoint was 30-day all-cause mortality. Exploratory analyses assessed treatment patterns by age, sex, geographical distance, and area-level income. Results: Among 59 patients (mean age 71.2 ± 10.7 years; 50.8% women), 17 (28.8%) had isolated VSR, 21 (35.6%) LVFWR, 10 (16.9%) combined VSR and contained LVFWR/pseudoaneurysm, and 11 (18.6%) PMR. Temporary mechanical circulatory support (MCS) and surgery were each used in 35 patients (59.3%). Thirty-day mortality was 59.3%. Among patients undergoing definitive invasive treatment, mortality was 45.7%. Older age was associated with higher 30-day mortality (OR per year 1.09, 95% CI 1.03–1.16), whereas surgery was associated with lower observed mortality (OR 0.22, 95% CI 0.07–0.73), acknowledging major treatment selection and survivor biases. Patients aged ≥75 years received MCS less frequently than younger patients (29.2% vs. 80.0%), and women underwent surgery less frequently than men (46.7% vs. 72.4%). Distance and area-level income were not associated with 30-day mortality. Conclusions: In a contemporary regional referral network, post-AMI MCs remained associated with extreme early mortality. Age and treatment selection were major determinants of observed outcomes, while marked age- and sex-related differences in treatment intensity warrant confirmation in larger multicenter cohorts.

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Cite

BibTeXRIS
BibTeX
@article{alen2026mechanical,
  title = {{Mechanical Complications After Acute Myocardial Infarction: Contemporary Management, Treatment Selection, and Outcomes in a 10-Year Regional Referral Network}},
  author = {Alberto Alén and Andrés Álvarez-Gato and Manuel Sánchez and Francisco González-Urbistondo and María Salgado and Rut Álvarez-Velasco and Miguel Ángel Rodríguez-Yago and María Isabel Soto and Jacobo Silva and Pablo Avanzas and Rebeca Lorca},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15207975},
  url = {https://www.mdpi.com/2077-0383/15/20/7975},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Mechanical Complications After Acute Myocardial Infarction: Contemporary Management, Treatment Selection, and Outcomes in a 10-Year Regional Referral Network
AU  - Alberto Alén
AU  - Andrés Álvarez-Gato
AU  - Manuel Sánchez
AU  - Francisco González-Urbistondo
AU  - María Salgado
AU  - Rut Álvarez-Velasco
AU  - Miguel Ángel Rodríguez-Yago
AU  - María Isabel Soto
AU  - Jacobo Silva
AU  - Pablo Avanzas
AU  - Rebeca Lorca
PY  - 2026
DA  - 2026/10/01
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15207975
UR  - https://www.mdpi.com/2077-0383/15/20/7975
AB  - Background: Mechanical complications (MCs) after acute myocardial infarction (AMI) are now uncommon but remain highly lethal, and contemporary data encompassing the full spectrum of rupture phenotypes are limited. Methods: We retrospectively identified all consecutive adults with post-AMI MCs managed at a tertiary regional referral center from 2015 to 2025. MCs included ventricular septal rupture (VSR), left ventricular free-wall rupture (LVFWR), contained rupture/pseudoaneurysm, and papillary muscle rupture (PMR). The primary endpoint was 30-day all-cause mortality. Exploratory analyses assessed treatment patterns by age, sex, geographical distance, and area-level income. Results: Among 59 patients (mean age 71.2 ± 10.7 years; 50.8% women), 17 (28.8%) had isolated VSR, 21 (35.6%) LVFWR, 10 (16.9%) combined VSR and contained LVFWR/pseudoaneurysm, and 11 (18.6%) PMR. Temporary mechanical circulatory support (MCS) and surgery were each used in 35 patients (59.3%). Thirty-day mortality was 59.3%. Among patients undergoing definitive invasive treatment, mortality was 45.7%. Older age was associated with higher 30-day mortality (OR per year 1.09, 95% CI 1.03–1.16), whereas surgery was associated with lower observed mortality (OR 0.22, 95% CI 0.07–0.73), acknowledging major treatment selection and survivor biases. Patients aged ≥75 years received MCS less frequently than younger patients (29.2% vs. 80.0%), and women underwent surgery less frequently than men (46.7% vs. 72.4%). Distance and area-level income were not associated with 30-day mortality. Conclusions: In a contemporary regional referral network, post-AMI MCs remained associated with extreme early mortality. Age and treatment selection were major determinants of observed outcomes, while marked age- and sex-related differences in treatment intensity warrant confirmation in larger multicenter cohorts.
SN  - 2077-0383
ER  -