Shi Tai1, Jian-Jun Tang1, Liang Tang1, Yu-Qing Ni1, Yanan Guo1, Xin-Qun Hu1, Zhen-Fei Fang1, Hong-Wei Pan2, He Huang3, Chang-Hui Liu4, Gao-Feng Zeng5, Sheng-Hua Zhou6. 1. Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China. 2. Department of Cardiology, Hunan Provincial People's Hospital, Changsha, China. 3. Department of Cardiology, Xiangtan Central Hospital, Xiangtan, China. 4. Department of Cardiology, The First Affiliated Hospital of University of South China, Hengyang, China. 5. Department of Cardiology, The Second Affiliated Hospital of University of South China, Hengyang, China. 6. Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China, zhoushenghua@csu.edu.cn.
Abstract
BACKGROUND: Postinfarction ventricular septal rupture (PI-VSR) is a rare but devastating complication of acute myocardial infarction (AMI). Risk stratification in the acute phase is crucial for decision-making, and this study analyzed the risk factors for early mortality and the effects of various management options on the outcome of PI-VSR patients in the era of percutaneous intervention. METHODS: A total of 96 patients with PI-VSR were identified and divided into an acute-phase survivor group (n = 46, survived ≥2 weeks after admission) and a nonsurvivor group (n = 50, died within 2 weeks after admission). Percutaneous closure was considered in acute-phase survivors. Patients were followed up for a mean 47 (quartiles 15-71) months by clinical visit or telephone interview. RESULTS: The overall acute-phase (i.e., < 2 weeks after the diagnosis of PI-VSR) mortality rate was 52%. Female sex and Killip Class III-IV at admission were associated with an increased risk of acute-phase death. Of the 46 patients who survived ≥2 weeks, 20 underwent interventional occlusion and the procedure was successful in 19. Percutaneous closure in the acute-phase survivor group improved the immediate (21% in-hospital mortality rate) and long-term (53% mortality) outcomes. CONCLUSIONS: Patients with PI-VSR are at a high risk of acute-phase mortality. Female sex and severe cardiac dysfunction at admission are linked with a high rate of acute-phase deaths. Percutaneous closure in acute-phase survivors results in favorable short- and long-term benefits for PI-VSR patients.
BACKGROUND: Postinfarction ventricular septal rupture (PI-VSR) is a rare but devastating complication of acute myocardial infarction (AMI). Risk stratification in the acute phase is crucial for decision-making, and this study analyzed the risk factors for early mortality and the effects of various management options on the outcome of PI-VSR patients in the era of percutaneous intervention. METHODS: A total of 96 patients with PI-VSR were identified and divided into an acute-phase survivor group (n = 46, survived ≥2 weeks after admission) and a nonsurvivor group (n = 50, died within 2 weeks after admission). Percutaneous closure was considered in acute-phase survivors. Patients were followed up for a mean 47 (quartiles 15-71) months by clinical visit or telephone interview. RESULTS: The overall acute-phase (i.e., < 2 weeks after the diagnosis of PI-VSR) mortality rate was 52%. Female sex and Killip Class III-IV at admission were associated with an increased risk of acute-phase death. Of the 46 patients who survived ≥2 weeks, 20 underwent interventional occlusion and the procedure was successful in 19. Percutaneous closure in the acute-phase survivor group improved the immediate (21% in-hospital mortality rate) and long-term (53% mortality) outcomes. CONCLUSIONS:Patients with PI-VSR are at a high risk of acute-phase mortality. Female sex and severe cardiac dysfunction at admission are linked with a high rate of acute-phase deaths. Percutaneous closure in acute-phase survivors results in favorable short- and long-term benefits for PI-VSR patients.