Authors

• Josip Silović — General Hospital ”Dr Josip Benčević”, Slavonski Brod, Croatia
• Domagoj Mišković — General Hospital ”Dr Josip Benčević”, Slavonski Brod, Croatia
• Katica Cvitkušić Lukenda — General Hospital ”Dr Josip Benčević”, Slavonski Brod, Croatia
• Krešimir Gabaldo — General Hospital ”Dr Josip Benčević”, Slavonski Brod, Croatia
• Marijana Knežević Praveček — General Hospital ”Dr Josip Benčević”, Slavonski Brod, Croatia

Keywords

mechanical complications, myocardial infarction, free wall rupture, septal rupture, cardiac tamponade, spontaneous cessation of bleeding, mortality

DOI

Full Text

**Introduction**: Mechanical complications of myocardial infarction (MI) represent rare but potentially fatal sequelae of acute MI that, despite advanced reperfusion therapies, maintain extremely high mortality rates (1, 2). These complications include left ventricular free wall rupture, interventricular septal rupture, papillary muscle rupture, and cardiac tamponade. Quick diagnosis is of utmost importance and echocardiography is the most available method for establishing it (3, 4). Aim: To analyze demographic characteristics, types of complications, management approaches, and short-term outcomes of patients with mechanical complications of MI treated at General Hospital Slavonski Brod during a five-year period. **Patients and Methods**: All patients with mechanical complications of MI hospitalized between January 2020 and October 2025 were retrospectively analyzed. Data were collected from the hospital information system and cardiology department database. Demographic characteristics, types of complications, infarct localization, culprit coronary vessels, management approaches, and short-term outcomes were analyzed. All diagnoses were confirmed by echocardiography. **Results**: A total of 11 patients were identified with a mean age of 73.8 years (range 61-88 years) and female predominance (54.5%). The most common complication was left ventricular free wall rupture (54.5%), followed by interventricular septal rupture (27.3%) and cardiac tamponade (18.2%). The right coronary artery was the most common culprit vessel (45.5%), while inferoposterior localization predominated in 36.4% of cases. Surgical management was applied in 54.5% of patients. Two cases had spontaneous cessation of bleeding without the need for surgical management: one case of cardiac tamponade where spontaneous cessation occurred after pericardiocentesis without a clear site of extravasation, and one case of free wall rupture with pseudoaneurysm formation. In one patient, percutaneous occlusion of the extravasation site with coils was successfully performed. Overall mortality was 30.0% (**Table 1**, **Figures 1** and **2**Figure 2). ### TABLE 1: Characteristics of patients with mechanical complications of myocardial infarction (General Hospital Slavonski Brod, 2020-2025). | **Patient** | **Age (years)** | **Sex** | **Complication Type** | **Culprit Vessel** | **Infarct Location** | **Management** | **Outcome** | | --- | --- | --- | --- | --- | --- | --- | --- | | 1 | 71 | F | Free wall rupture | RCA | Inferoposterior | Surgical | Survived | | 2 | 72 | F | Free wall rupture | RCA | Unspecified | Pericardiocentesis + coil occlusion | Survived | | 3 | 67 | M | Free wall rupture | RCA | Inferoposterior | Surgical (Patch repair) | Survived | | 4 | 64 | F | Cardiac tamponade | LCX | Lateral | Conservative | Deceased | | 5 | 74 | M | Free wall rupture | LAD | Anteroseptal | Conservative (pseudoaneurysm formation) | Survived | | 6 | 72 | M | Free wall rupture | LCX | Inferoposterior | Surgical | Survived | | 7 | 84 | F | Cardiac tamponade | Multiple culprits | Inferolateral | PCI + pericardiocentesis | Survived | | 8 | 68 | F | Free wall rupture | RIM | Inferolateral | Surgical | Deceased | | 9 | 60 | M | Septal rupture | RCA | Inferoposterior | Surgical (VSD patch) | Survived | | 10 | 87 | F | Septal rupture | LAD | Anteroseptal | Surgical | Deceased | | 11 | 68 | M | Septal rupture | RCA | Inferior | PCI + surgical | Unknown | [†] F – female; M – male; RCA – right coronary artery; LCx – left circumflex artery; LAD – Left anterior descending artery; PCI – percutaneous coronary intervention FIGURE 1. Survival outcomes by complication type. FIGURE 2. Number of patients by culprit vessel. **Conclusion**: Mechanical complications of MI occur more frequently in elderly women. Free wall rupture was the most common complication in our series. Mortality of 30.0% is significantly lower than published data, likely due to rapid echocardiographic diagnosis, 24/7 interventional cardiology availability, and established protocols for multidisciplinary management. Cases with spontaneous cessation of bleeding were identified where surgical management was not required, emphasizing the importance of individualized assessment of each patient. Surgical intervention remains the method of choice for definitive treatment whenever feasible, while percutaneous techniques are used selectively. RCA – right coronary artery; LCx – left circumflex artey; LAD – left anterior descending artery; RIM – ramus intermedius.

Literature

1. Gong FF, Vaitenas I, Malaisrie SC, Maganti K. Mechanical Complications of Acute Myocardial Infarction: A Review. JAMA Cardiol. 2021 March 1;6(3):341–9. https://doi.org/10.1001/jamacardio.2020.3690
2. Matteucci M, Ronco D, Kowalewski M, Massimi G, De Bonis M, Formica F, et al. Long-term survival after surgical treatment for post-infarction mechanical complications: results from the Caution study. Eur Heart J Qual Care Clin Outcomes. 2024 December 19;10(8):737–49. https://doi.org/10.1093/ehjqcco/qcae010
3. Damluji AA, van Diepen S, Katz JN, Menon V, Tamis-Holland JE, Bakitas M, et al. American Heart Association Council on Clinical Cardiology; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Surgery and Anesthesia; and Council on Cardiovascular and Stroke Nursing. Mechanical Complications of Acute Myocardial Infarction: A Scientific Statement From the American Heart Association. Circulation. 2021 July 13;144(2):e16–35. https://doi.org/10.1161/CIR.0000000000000985
4. López-Sendón J, González A, López de Sá E, Coma-Canella I, Roldán I, Domínguez F, et al. Diagnosis of subacute ventricular wall rupture after acute myocardial infarction: sensitivity and specificity of clinical, hemodynamic and echocardiographic criteria. J Am Coll Cardiol. 1992 May;19(6):1145–53. https://doi.org/10.1016/0735-1097(92)90315-E