Clinical Characteristics and Contemporary Prognosis of Ventricular Septal Rupture Complicating Acute Myocardial Infarction: A Single-Center Experience.

Lu Wang,Xiao-Fang Wang,Li-Li Xiao,Ling Li,Yan-Zhou Zhang,Jian-Zeng Dong,Xiao-Yan Zhao,Chao Liu

doi:10.3389/fcvm.2021.679148

Abstract

Objectives: Ventricular septal rupture (VSR) is a rare but lethal complication of acute myocardial infarction (AMI). We conducted a retrospective analysis of the clinical characteristics of VSR patients and explored the risk factors for long-term mortality.Methods: In this single-center cohort study, 127 patients diagnosed with post-AMI VSR between May 2012 and April 2019 were included. Demographic, clinical, operative, and outcome data were collected. The 30-day and long-term mortality were outcomes of interest. Cox proportional hazard regression analysis was used to explore the predictors of long-term mortality.Results: The mean age of the VSR cohort was 66.6 ± 8.7 years, 67 (52.8%) were males. Among the 127 patients, 78 patients (61.4%) were medically managed, 31 (24.4%) patients underwent percutaneous transcatheter closure (TCC), and 18 (14.2%) patients received surgical repair. The median follow-up time was 1129 days [interquartile range: 802–2019 days]. The 30-day mortality of the medically managed group, percutaneous TCC group, and surgical management group was 93.6, 22.6, and 11.1%, respectively; and the long-term mortality was 96.2, 25.8, and 22.2%, respectively. VSR repair treatment including surgical management (HR 0.01, 95% CI 0.001–0.09, p < 0.001) and percutaneous TCC (HR 0.09, 95% CI 0.03–0.26, p < 0.001) was associated with a better prognosis, and cardiogenic shock (CS) (HR 9.30, 95% CI 3.38–25.62, p < 0.001) was an independent risk factor of long-term mortality.Conclusions: The prognosis of VSR patients without operative management remains poor, especially in those complicated with CS. Timely and improved surgery treatment is needed for better outcomes in VSR patients.

Highlights

Ventricular septal rupture (VSR), a rare complication of acute myocardial infarction (AMI), remains one of the most challenging clinical problems to treat [1]
Between May 2012 and April 2019, a total of 127 patients with a diagnosis of VSR complicating AMI were consecutively enrolled in this analysis
Among the 127 VSR patients, 78 (61.4%) patients were medically managed which meant treated conservatively, 31 (24.4%) patients went through percutaneous transcatheter closure (TCC), and 18 (14.2%) patients underwent surgical repair

Summary

Introduction

Ventricular septal rupture (VSR), a rare complication of acute myocardial infarction (AMI), remains one of the most challenging clinical problems to treat [1]. Though the incidence of VSR has decreased to 0.2–0.5% with the advent of reperfusion strategies nowadays, [2, 3] the outcome of patients who develop VSR remains poor and appears almost unchanged over the last few decades [4]. In the real-world clinical practice, surgery procedures were often performed during the subacute and chronic periods (≥2 weeks after the initial detection of VSR) [7]. Percutaneous transcatheter closure (TCC) has emerged as an alternative to surgical closure of VSR but is mainly restricted to selected cases in which patients have small VSR in the subacute or chronic phase [9,10,11]. Current treatments for VSR vary greatly, but the results remain disappointing

Objectives

Methods

Results

Conclusion