{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T15:16:48Z","timestamp":1781191008565,"version":"3.54.1"},"reference-count":36,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T00:00:00Z","timestamp":1774051200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Mechanical complications after acute myocardial infarction (MI)\u2014ventricular septal rupture (VSR), free-wall rupture (FWR), and papillary muscle rupture (PMR)\u2014have become uncommon in the primary percutaneous coronary intervention (PCI) era, yet remain among the most lethal cardiovascular emergencies, with contemporary mortality largely driven by cardiogenic shock and delays to definitive treatment. Although major society documents agree on urgent imaging, early mechanical circulatory support when shock is present, and multidisciplinary decision-making, important transatlantic differences persist, particularly regarding timing of intervention in ventricular septal rupture. This review synthesises current surgical and transcatheter evidence and proposes a unified, physiology-centred framework integrating shock staging, anatomical feasibility, and response to mechanical support. We also introduce STABLE, a structured bedside checklist designed to support consistent daily triage across all three lesions and to align timing decisions with haemodynamic stabilisation rather than centre-specific habit.<\/jats:p>","DOI":"10.3390\/jcm15062399","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T09:48:42Z","timestamp":1774259322000},"page":"2399","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Mechanical Complications After Acute Myocardial Infarction: A Shock-Stage and Timing-Based Management Framework"],"prefix":"10.3390","volume":"15","author":[{"given":"Caius Glad","family":"Streian","sequence":"first","affiliation":[{"name":"Department VI Cardiology, Cardiovascular Surgery Clinic, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"},{"name":"Institute for Cardiovascular Diseases of Timisoara, Clinic of Cardiovascular Surgery, Gheorghe Adam Street, No. 13A, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7793-0335","authenticated-orcid":false,"given":"Ramona Cristina","family":"Novaconi","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Timisoara, Clinic of Cardiovascular Surgery, Gheorghe Adam Street, No. 13A, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9501-5530","authenticated-orcid":false,"given":"Iulia Raluca","family":"Munteanu","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Timisoara, Clinic of Cardiovascular Surgery, Gheorghe Adam Street, No. 13A, 300310 Timisoara, Romania"},{"name":"Doctoral School Medicine-Pharmacy, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"},{"name":"Advanced Research Center, Institute for Cardiovascular Diseases, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6744-8261","authenticated-orcid":false,"given":"Andrei Raul","family":"Manzur","sequence":"additional","affiliation":[{"name":"Doctoral School Medicine-Pharmacy, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian Grigore","family":"Merce","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Timisoara, Clinic of Cardiovascular Surgery, Gheorghe Adam Street, No. 13A, 300310 Timisoara, Romania"},{"name":"Doctoral School Medicine-Pharmacy, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"},{"name":"Advanced Research Center, Institute for Cardiovascular Diseases, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marciana Ionela","family":"Boca","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Timisoara, Clinic of Cardiovascular Surgery, Gheorghe Adam Street, No. 13A, 300310 Timisoara, Romania"},{"name":"Doctoral School Medicine-Pharmacy, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"},{"name":"Advanced Research Center, Institute for Cardiovascular Diseases, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucian Silviu","family":"Falnita","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Timisoara, Clinic of Cardiovascular Surgery, Gheorghe Adam Street, No. 13A, 300310 Timisoara, Romania"},{"name":"Advanced Research Center, Institute for Cardiovascular Diseases, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciprian Nicusor","family":"Dima","sequence":"additional","affiliation":[{"name":"Department VI Cardiology, Cardiovascular Surgery Clinic, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"},{"name":"Institute for Cardiovascular Diseases of Timisoara, Clinic of Cardiovascular Surgery, Gheorghe Adam Street, No. 13A, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian Petru","family":"Merce","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Timisoara, Clinic of Cardiovascular Surgery, Gheorghe Adam Street, No. 13A, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1697-311X","authenticated-orcid":false,"given":"Silvius Alexandru","family":"Pescariu","sequence":"additional","affiliation":[{"name":"Department VI Cardiology, Cardiovascular Surgery Clinic, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"},{"name":"Institute for Cardiovascular Diseases of Timisoara, Clinic of Cardiovascular Surgery, Gheorghe Adam Street, No. 13A, 300310 Timisoara, Romania"},{"name":"Advanced Research Center, Institute for Cardiovascular Diseases, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Iliescu","sequence":"additional","affiliation":[{"name":"Department of Surgery I\u2014Clinic of Surgical Semiotics & Thoracic Surgery, Center for Hepato-Biliary and Pancreatic Surgery, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7378-7787","authenticated-orcid":false,"given":"Dragos","family":"Cozma","sequence":"additional","affiliation":[{"name":"Department VI Cardiology, Cardiovascular Surgery Clinic, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"},{"name":"Institute for Cardiovascular Diseases of Timisoara, Clinic of Cardiovascular Surgery, Gheorghe Adam Street, No. 13A, 300310 Timisoara, Romania"},{"name":"Advanced Research Center, Institute for Cardiovascular Diseases, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4870-8249","authenticated-orcid":false,"given":"Horea Bogdan","family":"Feier","sequence":"additional","affiliation":[{"name":"Department VI Cardiology, Cardiovascular Surgery Clinic, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Sq. No. 2, 300041 Timisoara, Romania"},{"name":"Institute for Cardiovascular Diseases of Timisoara, Clinic of Cardiovascular Surgery, Gheorghe Adam Street, No. 13A, 300310 Timisoara, Romania"},{"name":"Advanced Research Center, Institute for Cardiovascular Diseases, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","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":"ref_2","first-page":"29","article-title":"SCAI Clinical Expert Consensus Statement on the Classification of Cardiogenic Shock: This Document Was Endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the Society of Critical Care Medicine (SCCM), and the Society of Thoracic Surgeons (STS) in April 2019","volume":"94","author":"Baran","year":"2019","journal-title":"Catheter. 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