{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T06:30:43Z","timestamp":1764657043174,"version":"3.46.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:00:00Z","timestamp":1764633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The mortality rate for mechanical complications in very elderly acute myocardial infarction (AMI) patients is extremely high, but predictive tools specifically for this population are lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Mechanical complications (free-wall rupture, ventricular septal rupture, papillary muscle rupture\/dysfunction, ventricular aneurysm) were independently validated. Differences in baseline characteristics, laboratory markers, and outcomes were compared. Missing data underwent sensitivity analysis, with &amp;gt;20% exclusion and &amp;lt;15% imputation. Regression modeling entered variables with univariate association (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05) or clinical relevance into multivariable logistic regression; final model derived via backward elimination (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05 retained) with VIF\u202f&amp;gt;\u202f5 exclusion. Analyses used SPSS\/GraphPad (two-tailed\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study analyzed 2,467 consecutive AMI patients aged \u2265 75\u202fyears. Mechanical complications occurred in 9.6% (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f236) of patients. Ventricular aneurysm (VA) predominated (92.8%), strongly associated with anterior infarcts (71.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and reperfusion (81.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Rupture complications favored non-reperfused infarcts. Patients with mechanical complications exhibited distinct profiles: lower systolic blood pressure (115.9 vs. 123.5\u202fmmHg,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.001), higher STEMI prevalence (60.6% vs. 44.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), advanced Killip class III-IV (22.5% vs. 13.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), and biomarker evidence of intense inflammation (elevated WBC, neutrophil%, hs-CRP), myocardial injury (higher cTnT, NT-proBNP), and metabolic derangements (hypoalbuminemia, hyperkalemia). Multivariable analysis identified independent predictors: Killip class III\/IV (OR\u202f=\u202f2.99), elevated neutrophil percentage (OR\u202f=\u202f1.05), hyperkalemia (OR\u202f=\u202f1.70), and hypoalbuminemia (OR\u202f=\u202f0.92). A history of hypertension was paradoxically protective (OR\u202f=\u202f0.50).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study identifies ventricular aneurysm as the dominant mechanical complication in very elderly AMI patients, establishes a paradoxical protective role of hypertension history, and proposes a distinct risk profile integrating hemodynamic status, neutrophilic inflammation, and metabolic derangement. These findings are hypothesis-generating and highlight a potentially valuable stratification tool that warrants prospective validation in external cohorts before clinical application.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1714080","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T06:27:02Z","timestamp":1764656822000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors for mechanical complications in very elderly patients with acute myocardial infarction"],"prefix":"10.3389","volume":"12","author":[{"given":"Luqin","family":"Yan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e6","DOI":"10.1161\/cir.0000000000000741","article-title":"Older adults in the cardiac intensive care unit: factoring geriatric syndromes in the management, prognosis, and process of care: a scientific statement from the American Heart Association","volume":"141","author":"Damluji","year":"2020","journal-title":"Circulation"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e16","DOI":"10.1161\/cir.0000000000000985","article-title":"Mechanical complications of acute myocardial infarction: a scientific statement from the American Heart Association","volume":"144","author":"Damluji","year":"2021","journal-title":"Circulation"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1890","DOI":"10.1016\/j.jacc.2019.01.055","article-title":"Percutaneous coronary intervention in older patients with ST-segment elevation myocardial infarction and cardiogenic shock","volume":"73","author":"Damluji","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e013686","DOI":"10.1161\/jaha.119.013686","article-title":"Frailty among older adults with acute myocardial infarction and outcomes from percutaneous coronary interventions","volume":"8","author":"Damluji","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2149","DOI":"10.1016\/j.jacc.2018.03.022","article-title":"Multimorbidity in older adults with cardiovascular disease","volume":"71","author":"Forman","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.arr.2017.01.003","article-title":"Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: results from a meta-analysis and exploratory meta-regression analysis","volume":"35","author":"Veronese","year":"2017","journal-title":"Ageing Res Rev"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e50","DOI":"10.22037\/aaem.v11i1.2001","article-title":"HEART versus GRACE score in predicting the outcomes of patients with acute coronary syndrome; a systematic review and Meta-analysis","volume":"11","author":"Kabiri","year":"2023","journal-title":"Arch Acad Emerg Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2210","DOI":"10.3390\/jcm10102210","article-title":"Association of GRACE risk score with coronary artery disease complexity in patients with acute coronary syndrome","volume":"10","author":"Sofidis","year":"2021","journal-title":"J Clin Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1060","DOI":"10.1007\/s00380-020-01586-0","article-title":"A multicenter study on the clinical characteristics and risk factors of in-hospital mortality in patients with mechanical complications following acute myocardial infarction","volume":"35","author":"Koeda","year":"2020","journal-title":"Heart Vessel"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1401","DOI":"10.1016\/j.amjmed.2022.08.017","article-title":"Mechanical complications of myocardial infarction","volume":"135","author":"Murphy","year":"2022","journal-title":"Am J Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1001\/jamacardio.2020.3690","article-title":"Mechanical complications of acute myocardial infarction: a review","volume":"6","author":"Gong","year":"2021","journal-title":"JAMA Cardiol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1093\/ehjqcco\/qcae010","article-title":"Long-term survival after surgical treatment for post-infarction mechanical complications: results from the caution study","volume":"10","author":"Matteucci","year":"2024","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1093\/ehjacc\/zuad113","article-title":"Percutaneous coronary intervention for ST-elevation myocardial infarction complicated by cardiogenic shock in a super-aging society","volume":"12","author":"Nishihira","year":"2023","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"E498","DOI":"10.59958\/hsf.7475","article-title":"Influencing factors and survival analysis of late readmission after percutaneous coronary intervention in patients with acute myocardial infarction","volume":"27","author":"Zhou","year":"2024","journal-title":"Heart Surg Forum"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1093\/ehjacc\/zuaf039","article-title":"Outcomes with mechanical circulatory support devices among patients with mechanical complications of acute myocardial infarction","volume":"14","author":"Younes","year":"2025","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"750","DOI":"10.11909\/j.issn.1671-5411.2017.12.005","article-title":"Congenital left ventricular aneurysms and diverticula: an entity in search of an identity","volume":"14","author":"Ohlow","year":"2017","journal-title":"J Geriatr Cardiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1161\/01.cir.0000048892.83521.58","article-title":"Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: part I: aging arteries: a \"set up\" for vascular disease","volume":"107","author":"Lakatta","year":"2003","journal-title":"Circulation"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1161\/01.cir.0000048893.62841.f7","article-title":"Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: part II: the aging heart in health: links to heart disease","volume":"107","author":"Lakatta","year":"2003","journal-title":"Circulation"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1007\/s10741-011-9270-2","article-title":"Age-associated changes in cardiovascular structure and function: a fertile milieu for future disease","volume":"17","author":"Fleg","year":"2012","journal-title":"Heart Fail Rev"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"308","DOI":"10.33963\/KP.a2022.0293","article-title":"Left ventricular aneurysm: truths and falsehoods","volume":"81","author":"Zio\u0142o","year":"2023","journal-title":"Kardiol Pol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"326","DOI":"10.14503\/thij-16-6068","article-title":"Left ventricular reconstruction for Postinfarction left ventricular aneurysm: review of surgical techniques","volume":"44","author":"Ruzza","year":"2017","journal-title":"Tex Heart Inst J"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"103877","DOI":"10.1016\/j.jaccas.2025.103877","article-title":"Postinfarction left ventricular Inferior Wall aneurysm with contained rupture and tamponade physiology","volume":"30","author":"Painter","year":"2025","journal-title":"JACC Case Rep"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e43696","DOI":"10.1097\/md.0000000000043696","article-title":"Diagnosis and treatment of post-acute myocardial infarction ventricular aneurysm: a review","volume":"104","author":"Ma","year":"2025","journal-title":"Medicine"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.1213\/ane.0000000000007188","article-title":"Risk of acute complications with Rocuronium versus Cisatracurium in patients with chronic kidney disease: a propensity-matched study","volume":"140","author":"Georgakis","year":"2025","journal-title":"Anesth Analg"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1576","DOI":"10.1007\/s00392-024-02459-6","article-title":"Myocardial work in chronic kidney disease: insights from the CPH-CKD ECHO study","volume":"113","author":"Olsen","year":"2024","journal-title":"Clin Res Cardiol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1097\/shk.0000000000002433","article-title":"Clinical outcomes of patients with cardiogenic shock complicating acute myocardial infarction: the GULF-cardiogenic shock registry","volume":"62","author":"Daoulah","year":"2024","journal-title":"Shock"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1714080\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T06:27:06Z","timestamp":1764656826000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1714080\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,2]]},"references-count":26,"alternative-id":["10.3389\/fmed.2025.1714080"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1714080","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,2]]},"article-number":"1714080"}}