Vikas Singh1, Alex P Rodriguez2, Parth Bhatt3, Carlos E Alfonso2, Rahul Sakhuja4, Igor F Palacios4, Ignacio Inglessis-Azuaje4, Mauricio G Cohen2, Sammy Elmariah4, William W O'Neill5. 1. Interventional Cardiology, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston. Electronic address: vikas.dr.singh@gmail.com. 2. Cardiovascular Division, University of Miami, Miller School of Medicine, Fla. 3. Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock. 4. Interventional Cardiology, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston. 5. Division of Cardiology, Henry Ford Hospital, Detroit, Mich.
Abstract
BACKGROUND: Ventricular septal defect is a lethal complication after an acute myocardial infarction, which has become infrequent with the advent of reperfusion strategies; however, it remains a major contributor to mortality. METHODS: We identified patients using the International Classification of Diseases, 9th Revision, Clinical Modification procedure codes from the Nationwide Inpatient Sample between the years 2001 and 2013. A multivariate hierarchical logistic regression model was used to identify significant predictors of in-hospital mortality. RESULTS: We identified 3,373,206 ST-elevation myocardial infarctions, out of which 10,012 (0.3%) were complicated with ventricular septal defects. Most of the patients (60%) were older than 65 years, male (55%), and white (63%). Inferior (49.7%) and anterior (41.1%) myocardial infarctions were more commonly implicated with the development of ventricular septal defects. The median (interquartile range) hospitalization length was 7 (3.0-13.5) days. Only 7.65% of patients underwent some intervention, with 7% surgical and 0.65% minimally invasive. Mechanical support devices were used in 36.5% of patients, with intra-aortic balloon pump (96%) being the most common. In-hospital mortality remained high at 30.5% (downward trending from 41.6% in 2001 to 23.3% in 2013). Age, cardiogenic shock, and in-hospital cardiac arrest were statistically significant predictors of in-hospital mortality. The utilization of corrective procedures significantly declined. The use of mechanical support devices and performing a corrective procedure were associated with higher mortality, length of stay, and cost. CONCLUSIONS: Ventricular septal defects after acute myocardial infarctions remain associated with significantly high mortality rates. Highly specialized regional centers with individual expertise in the management of septal ruptures are required to improve outcomes of these patients.
BACKGROUND:Ventricular septal defect is a lethal complication after an acute myocardial infarction, which has become infrequent with the advent of reperfusion strategies; however, it remains a major contributor to mortality. METHODS: We identified patients using the International Classification of Diseases, 9th Revision, Clinical Modification procedure codes from the Nationwide Inpatient Sample between the years 2001 and 2013. A multivariate hierarchical logistic regression model was used to identify significant predictors of in-hospital mortality. RESULTS: We identified 3,373,206 ST-elevation myocardial infarctions, out of which 10,012 (0.3%) were complicated with ventricular septal defects. Most of the patients (60%) were older than 65 years, male (55%), and white (63%). Inferior (49.7%) and anterior (41.1%) myocardial infarctions were more commonly implicated with the development of ventricular septal defects. The median (interquartile range) hospitalization length was 7 (3.0-13.5) days. Only 7.65% of patients underwent some intervention, with 7% surgical and 0.65% minimally invasive. Mechanical support devices were used in 36.5% of patients, with intra-aortic balloon pump (96%) being the most common. In-hospital mortality remained high at 30.5% (downward trending from 41.6% in 2001 to 23.3% in 2013). Age, cardiogenic shock, and in-hospital cardiac arrest were statistically significant predictors of in-hospital mortality. The utilization of corrective procedures significantly declined. The use of mechanical support devices and performing a corrective procedure were associated with higher mortality, length of stay, and cost. CONCLUSIONS:Ventricular septal defects after acute myocardial infarctions remain associated with significantly high mortality rates. Highly specialized regional centers with individual expertise in the management of septal ruptures are required to improve outcomes of these patients.
Authors: Anju Bhardwaj; Sachin Kumar; Ismael A Salas de Armas; Angelo Nascimbene; Sriram Nathan; Biswajit Kar; Igor D Gregoric Journal: Ann Cardiothorac Surg Date: 2022-05
Authors: Jonas Lanz; Dörte Wyss; Lorenz Räber; Stefan Stortecky; Lukas Hunziker; Stefan Blöchlinger; David Reineke; Lars Englberger; Thomas Zanchin; Marco Valgimigli; Dik Heg; Stephan Windecker; Thomas Pilgrim Journal: PLoS One Date: 2019-02-22 Impact factor: 3.240