Blunt chest trauma as a cause of acute myocardial infarction

Myocardial Infarction Due to Coronary Artery Injury following High Force Blunt Trauma to the Upper Chest: A Case Illustrating the Prehospital, Hospital and Autopsy Findings

Myocardial infarction (MI) is a rare complication of blunt chest trauma (BCT). We describe an extensive antero-lateral MI due to thrombosis of the left main stem coronary artery following a blow to the lower face and upper anterior chest during an industrial accident in a 52-year-old male. The patient presented with acute left ventricular failure. Our case highlights MI as an important differential in a BCT patient presenting with hypoxia where lung pathology has been excluded. We aim to highlight the importance of cardiac assessment in trauma scenarios particularly where patients are unable to report symptoms. Our patient sadly did not survive his injuries. This case describes MI following BCT from the initial prehospital presentation through to postmortem findings and adds to the limited literature on the pathological mechanisms underpinning this rare complication.

Incidence and Outcomes of Acute Myocardial Infarction During Motor Vehicle Accident Related Hospitalizations

Data on Motor Vehicle Accidents (MVA) associated acute myocardial infarctions (AMI) are scares. We aimed to examine the frequency, characteristics, and outcomes of AMI among patients admitted with MVA. Patients hospitalized with Motor Vehicle Traffic Accidents (ICD-9-CM codes e810-e819) in 2003 to 2014 were identified in the national inpatient sample. The primary end point was crude and risk-adjusted in-hospital mortality in patients with and without AMI. Secondary end-points were major morbidities, and resource utilization metrics. A total of 573,717 patients were hospitalized after MVAs in 2003 to 2014, of whom 2,793 (0.5%) suffered an AMI (26% STEMI and 74% NSTEMI). Patients who suffered AMI were older, and had higher rates of hypertension, diabetes, hyperlipidemia, renal insufficiency, and vascular disease. In the AMI group, angiography was performed in 26.7%, and among those, 42.2% received percutaneous intervention and 9.2% underwent coronary artery bypass surgery during the same admission. In-hospital mortality was higher in patients with AMI compared with patients without MI (21.7% vs 2.7%, p <0.001). After adjusting for age, gender, race, co-morbidities, and hospital characteristics, AMI remained associated with significantly higher mortality (adjusted overall [OR] 6.3, 95% confidence interval [CI] 5.98 to 6.57, p< 0.001). Patients with AMI had higher incidences of cardiac arrest (11.9% vs 0.7%, p <0.001), new dialysis (2.2% vs 0.1%, p <0.001), and stroke (4.1% vs 0.5%, p <0.001). They also had longer hospitalizations (12 ± 17 vs 6 ± 10 days, p <0.001), higher cost ($48046 ± 56316 vs $20820 ± 31758, p <0.001), and higher rates of nonhome discharges (55.5% vs 15.4%, p <0.001). In conclusion: AMI in patients admitted with MVA is uncommon but is associated with substantial morbidity, mortality, and cost.