The Clinical Characteristics of Acute Myocardial Infarction with Ventricular Septal Perforation and the Prognosis Comparison of Different Treatment Methods

Background: To explore the clinical characteristics of acute myocardial infarction (AMI) with ventricular septal perforation (VSR) and the prognosis comparison of different treatment methods, as well as the analysis of related risk factors.Methods: From January 2006 to February 2020, 29 patients with AMI and VSR diagnosed in the people's Hospital of Peking University were selected as the study object, among them, 16 cases were male (55.2%), 13 cases were female (44.8%), the average age was 64.69 ± 10.32 years old, and they were divided into survival group (n=16) and non-survival group (n=13) according to whether they survive within 30 days of surgical or drug conservative treatment.The clinical characteristics, coronary angiography and treatment of the two groups were summarized, and the prognosis and related risk factors were analyzed.Results: There was no significant difference in the basic clinical characteristics between the two groups(P>0.05)；Compared with the results of coronary angiography in the two groups, the proportion of the culprit vessel which was a simple anterior descending branch in the non-survival group was higher than that in the survival group, there was a statistical difference between the two groups(P<0.05)；The peri-operative data of the two groups showed that the proportion of patients with complete revascularization, simultaneous bypass and recanalization of culprit vessels in the survival group was significantly higher than that in the non- survival group (P < 0.05)；However, the incidence of postoperative low cardiac output and mortality during hospitalization in the survival group were significantly lower than those in the non-survival group (P < 0.05)；Logistic regression analysis showed that complete revascularization (OR = 0.021, 95% CI 0.001-0.374, P = 0.009), recanalization of culprit vessels (OR = 0.045, 95% CI 0.004-0.548, P = 0.015) were independent risk factors for 30 day mortality。Kaplan-Meier survival curve showed that during the follow-up period, the long-term survival rate of patients with operation and complete revascularization was significantly higher than that of patients with drug conservative treatment and incomplete revascularization, there was a statistical difference between the two groups (P < 0.05).Conclusions: Whether complete revascularization and recanalization of culprit vessels or not are independent risk factors for 30 day mortality in patients with AMI and VSR；the long-term survival rate of patients after surgery and complete revascularization is significantly higher than that of patients with conservative medical treatment and incomplete revascularization. Surgery and complete revascularization are important factors affecting the long-term prognosis of patients with AMI and VSR.