Mechanical Complications of Acute Myocardial Infarction: an International Multicenter Cohort Study During COVID-19 Pandemics (CautionCov19)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 130
- 试验地点
- 1
- 主要终点
- In-hospital survival
研究概览
简要总结
The ongoing COVID-19 pandemics has put an overwhelming pressure on the healthcare systems of many European countries. Such a situation has potentially led to delayed and impaired access to appropriate treatment for patients affected by other severe, non-COVID-19-related conditions, including cardiovascular diseases. This resulted in a reported lower admission, but higher mortality rate for AMI patients.
Such a situation might be explained by many factors, including unavailability of early reperfusion therapy and late hospital presentation of AMI patients due to a general anxiety related to the COVID-19 contagious risk of the hospital environment. As a matter of fact, during this year of pandemics, several case reports suggested a new, significant surge of post-AMI mechanical complications, sometimes describing patients admitted in too severe conditions to consider surgical repair a viable option, and therefore inevitably undergone an unfavorable outcome.
Therefore, we decided to involve the large network of European centers already participating to the "Caution Study 1", in order to study the impact of COVID-19 pandemics on the outcomes, incidence and treatments of post-AMI mechanical complications.
详细描述
Mechanical complications must be carefully searched for in any patient with an acute coronary syndrome and signs of cardiogenic shock, as prompt diagnosis and immediate surgery often represent the only effective treatment for such ominous conditions.
The management of patients with postinfarction mechanical complications requires the consideration of several factors: (i) the extremely poor prognosis without surgical treatment; (ii) the higher mortality risk associated with emergency surgery; (iii) the potential rapid deterioration of initially stable patients.
Data from the Society of Thoracic Surgeons National Database demonstrated an average 43% in-hospital/30-day mortality for surgical treatment of ventricular septal rupture. Data from the same registry on papillary muscle rupture showed a 30-day mortality of 20%. Matteucci et al. recently reported a 36.4% mortality rate for free wall rupture from the large CAUTION multicenter study.
Given the low incidence of these post-AMI mechanical complications, evidence-based therapeutic strategies remain controversial, and little is known on the early clinical results and late follow-up, with most information derived from small single-center experiences or national registries.
Therefore, we started the "Mechanical complications of acute myocardial infarction: an international multicenter cohort study" - (Caution Study 1), a retrospective, international multicenter clinical trial aimed at evaluating the survival, postoperative outcome and quality of life of patients undergone cardiac surgery for post-infarction mechanical complications starting from 2001.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •patients ≥ 18 years old;
- •recent diagnosis of acute myocardial infarction;
- •presence of ventricular free-wall rupture and/or ventricular septal rupture and/or papillary muscle rupture.
排除标准
- •patients < 18 years old;
- •ventricular free-wall rupture or ventricular septal rupture or papillary muscle rupture not related with acute myocardial infarction.
结局指标
主要结局
In-hospital survival
时间窗: interval from intervention (surgical or percutaneous) to hospital discharge (expected: up to 4 weeks)
To assess the in-hospital survival rate of patients admitted with a diagnosis of post-AMI mechanical complications and underwent surgical or percutaneous treatment
次要结局
未报告次要终点