Abstract 11235: Timing of Repair in Post-Infarction Ventricular Septal Defect

Abstract

Background: Post-infarction ventricular septal defect (PIVSD) formation is a rare but devastating complication of ST-elevation myocardial infarction (STEMI). Objective: To determine the association of the timing of VSD repair on in-hospital mortality in patients with PIVSD. Methods: This retrospective cohort study identified 10,902 patients with VSD and STEMI from the Nationwide Readmissions Database from 2003-2018. VSD repair was identified by appropriate ICD9 and ICD10 codes. Patients were stratified based on intervention timing: 0-7 days, 8-14 days, and > 14 days after admission. The primary outcome was in-hospital mortality. Outcomes of patients who received VSD repair were compared patients who did not receive VSD repair within the same time-point. Multivariate logistic regressions were used to adjust for demographic, comorbid, and socioeconomic factors. Analysis was stratified by clinical presentation of cardiogenic shock. Results: In patients in shock, there was a significant decrease in in-hospital mortality with VSD repair at 0-7 days (50.8% vs. 60.4%; OR 0.76; 95% CI 0.68-0.86, p<0.001) as compared to at risk patients who did not undergo VSD repair (Table 1). There was no difference in in-hospital mortality in patients receiving VSD repair at 8-14 days or at > 14 days as compared to who did not undergo VSD repair. In patients not in shock, there was an increase in in-hospital mortality in patients who received VSD repair from 0-7 days (23.8% vs 36%; OR 1.59; 95% CI 1.33-1.90; p<0.001) at compared to those who did not receive VSD repair. There was no significant difference in outcomes in patients not in shock who received VSD repair at 8-14 days or at >14 days as compared to those at who did not receive VSD repair at this timepoint. Conclusions: Early PIVSD repair was associated with a significantly decreased rate of in-hospital mortality in patients in shock, but was associated with significantly higher rate of in-hospital mortality in patients not in shock