Mechanical Complications of Acute Myocardial Infarction
Trial name: “MeChanical complicAtion of acUte myocardial infarcTion: an InternatiOnal
multiceNter cohort study (CAUTION Study)
Principal investigators: Prof Roberto Lorusso (Maastricht, The Netherlands), Dr Matteo Matteucci
(Varese, Italy).
Registration: Clinicaltrials.gov, NCT03848429.
Design: Retrospective, multicenter, observational.
Background: With the advent of reperfusion strategies for acute myocardial infarction, including
thrombolysis and percutaneous coronary intervention, post-infarction mechanical complications,
such as left ventricular free-wall rupture, ventricular septal rupture and papillary muscle rupture,
have become increasingly uncommon. Because of the rarity of these post-infarction sequalae, most
published reports on this topic consist of single-center experiences with small sample size, and little
is known about the clinical results of surgical treatment, particularly regarding in-hospital results.
Objective: To investigate the in-hospital and long-term outcome of patients undergoing cardiac
surgery for mechanical complication of AMI.
Publications:
- Surgical Treatment of Post-Infarction Left Ventricular Free-Wall Rupture: A Multicenter Study
2. CAUTION PMR study: Surgical treatment for post-infarction papillary muscle rupture: a multicentre study
Historically, mechanical complications following acute myocardial infarction have been associated with very high morbidity and mortality. Despite their incidence plummeted with the advent of acute reperfusion therapy, such as thrombolysis and percutaneous coronary intervention, contemporary data on the outcomes of patients who develop such ominous complications are scarce. CAUTION study (NCT03848429), a retrospective, international, multicenter study aimed at evaluating the survival and postoperative outcomes of patients undergoing cardiac surgery for post-infarction mechanical complications. The recent publications from this registry, CAUTION PMR study (DOI: 10.1093/ejcts/ezab469) and CAUTION VSR study (DOI: 10.1001/jamanetworkopen.2021.28309), revealed an early mortality of 24.8% and 40.4% for subjects underwent surgical treatment for post-infarction papillary muscle rupture (PMR) and VSR (ventricular septal rupture), respectively. In light of this, further efforts of the health community should be directed toward improving therapeutic measures in an attempt to improve in-hospital survival of these critical subgroups of patients. Furthermore, publications investigating the long-term outcomes of patients undergoing surgery for post-infarction mechanical complications are warranted.
3. CAUTION VSR study: Surgical Treatment of Postinfarction Ventricular Septal Rupture
TRC 