Key result
VSR repair treatment, including surgical management (HR 0.01) and percutaneous transcatheter closure (HR 0.09), significantly reduced long-term mortality compared to medical management.
Why the study?
Ventricular septal rupture is a rare but lethal complication of AMI, motivating an analysis of clinical characteristics and risk factors for long-term mortality.
Does VSR repair treatment (surgical or percutaneous transcatheter closure) improve long-term mortality compared to medical management alone in patients with post-AMI ventricular septal rupture?
Cohort (n=127)
No
Does VSR repair treatment (surgical or percutaneous transcatheter closure) improve long-term mortality compared to medical management alone in patients with post-AMI ventricular septal rupture?
Hazard Ratio: 0.01 (95% CI 0.001–0.09)
Absolute Event Rate: 22.2% vs 96.2%
p-value: p=<0.001
In patients with post-AMI ventricular septal rupture, operative management (surgical or percutaneous closure) is associated with significantly improved survival compared to medical management alone, though cardiogenic shock remains a major predictor of mortality.
Repair strategies associated with lower mortality than medical management in post-AMI VSR; supports hypothesis-generating role for intervention timing and selection.
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.
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Wang et al. (2021) conducted a cohort in Ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI) (n=127). Surgical management or percutaneous transcatheter closure vs. Medical management was evaluated on Long-term mortality (HR 0.01, 95% CI 0.001-0.09, p=<0.001). VSR repair treatment, including surgical management (HR 0.01) and percutaneous transcatheter closure (HR 0.09), significantly reduced long-term mortality compared to medical management.
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