Key result
IRA revascularization shows no long-term mortality benefit over no revascularization in post-infarction ventricular septal rupture.
Why the study?
While surgical repair is definitive for post-infarction ventricular septal rupture, the optimal revascularization strategy remains uncertain.
Does infarct-related artery revascularization or complete revascularization improve long-term survival or reduce MACCE in patients with post-infarction ventricular septal rupture undergoing surgical repair?
Cohort (n=132)
No
Does infarct-related artery revascularization or complete revascularization improve long-term survival or reduce MACCE in patients with post-infarction ventricular septal rupture undergoing surgical repair?
Hazard Ratio: 0.62 (95% CI 0.22–1.79)
Absolute Event Rate: 18.3% vs 17.9%
p-value: p=0.376
In patients with post-infarction ventricular septal rupture undergoing surgical repair, complete revascularization reduces MACCE in those with multi-vessel disease, although IRA revascularization alone does not improve long-term survival.
Complete revascularization was associated with lower MACCE risk in post-MI VSR; leaves open optimal strategy pending randomized trials.
Background: Ventricular septal rupture (VSR) is a life-threatening complication of myocardial infarction. While surgical repair is regarded as the definitive treatment, the optimal approach to revascularization remains uncertain. This study aims to evaluate the effects of infarct-related artery (IRA) revascularization and the completeness of revascularization on long-term survival and the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in patients with VSR. Methods: This retrospective study analyzed 132 VSR patients who underwent surgical repair at the Fuwai Hospital from 2004 to 2022. Patients were categorized based on whether they received IRA revascularization. For those with multi-vessel disease (MVD), revascularization was classified as complete or incomplete. The primary outcome was all-cause mortality, with a mean follow-up of 77.8 months (median 71.0 months). The secondary outcome was MACCE. Results: Of the 132 patients, 28 did not undergo IRA revascularization. Kaplan-Meier analysis showed similar all-cause mortality and MACCE rates between patients with and without IRA revascularization. Adjusted Cox regression confirmed no significant association between IRA revascularization and long-term mortality (adjusted hazard ratio [aHR], 0.62; 95% CI: 0.22-1.79) or MACCE (aHR, 1.30; 95% CI: 0.52-3.27). These findings were consistent across both single-vessel and MVD patients. Among the 84 MVD patients, 53 underwent complete revascularization. Patients with complete revascularization had a lower incidence of MACCE (aHR, 0.26; 95% CI: 0.10-0.67) compared to those with incomplete revascularization, although no significant difference in mortality was observed (aHR, 0.57; 95% CI: 0.17-1.85). Conclusions: IRA revascularization does not affect long-term survival or MACCE rates in VSR patients. However, complete revascularization significantly reduces the risk of MACCE in patients with MVD.
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Ma et al. (2025) conducted a cohort in Post-infarction ventricular septal rupture (n=132). Infarct-related artery (IRA) revascularization vs. No IRA revascularization was evaluated on All-cause mortality (HR 0.62, 95% CI 0.22-1.79, p=0.376). Infarct-related artery revascularization did not significantly affect long-term all-cause mortality compared to no revascularization in patients with post-infarction ventricular septal rupture (HR 0.62).
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