Incidence and predictors of 30-day mortality in patients with ventricular septal rupture complicating acute myocardial infarction

Pradhan, Akshyaya; Jain, Nityanand; Cassese, Salvatore; Vishwakarma, Pravesh; Sethi, Rishi; Chandra, Sharad; Chaudhary, Gaurav; Dwivedi, Sudhanshu Kumar; Narain, Varun Shankar

doi:10.1136/heartasia-2018-011062

Cited by 7 publications

(12 citation statements)

References 17 publications

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“…This is comparatively lower than the 1–3% VSR rate reported in studies conducted in the pre-reperfusion era [ 17 ]. In a study conducted in India, the rate of VSR was comparable to our findings (0.7%) [ 18 ]. However, the incidence of VSR in the GUSTO-1(Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) trial was slightly lower (0.2–0.4%) as compared to our findings [ 19 ].…”

Section: Discussionsupporting

confidence: 89%

“…Our in-hospital VSR related mortality rate was 65.7%. However, a study conducted in similar resource-limited settings on post-MI VSR patients suggested a higher rate (80.4%) of in-hospital mortality [ 18 ]. In contrast, findings from developed countries exhibited comparatively lower rates of early VSR related mortality ranging from 35%-54% [ 17 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

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Management and outcome of post-myocardial infarction ventricular septal rupture—A Low-Middle-Income Country Experience

Aijaz

Peerwani²,

Bugti³

et al. 2022

PLoS ONE

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Background Ventricular septal rupture (VSR) is a rare complication after acute myocardial infarction (AMI) especially in the reperfusion era but its associated mortality has remained high. This case series evaluated in-hospital and intermediate-term mortality in VSR patients. Additionally, we also analyzed risk factors, clinical presentation, intervention, and predictors of in-hospital mortality in VSR patients. Methods Data of 67 patients with echocardiography confirmed diagnosis of VSR from January 2011 to April 2020 was extracted from hospital medical records. Records were also reviewed to document 30 day and 1-year mortality, recurrent heart failure admission, repeat myocardial infarction, and revascularization. In addition, telephonic follow-up was done to assess health-related quality of life(HRQOL) assessed by KCCQ-12. SCAI shock classification was used to categorize severity of cardiogenic shock. Univariate and multivariable logistic regression was used to determine predictors of in-hospital mortality. Survival function was presented using the Kaplan-Meier survival curve. Results Mean age of patients was 62.7 ± 11.1 years, 62.7% were males. 65.7% of the patients presented more than 24 hours after MI and did not receive reperfusion therapy. Median time from AMI to VSR diagnosis was 2 (1–5) days. VSR closure was attempted in 53.7% patients. In-hospital mortality was 65.7%. At univariate level, predictors of in-hospital mortality were non-surgical management, basal VSR, right ventricular dysfunction, early VSR post-MI, and severe cardiogenic shock at admission (class C, D, or E). Adjusted predictors of in-hospital mortality included non-surgical management, basal VSR and advanced cardiogenic shock. There were 5 deaths during median followup of 44.1 months. HRQOL in patients available on followup was good (54.5%) or excellent (45.5%). Conclusion High in-hospital mortality was seen in VSR patients. VSR closure is the preferred treatment to get long-term survival, however, timing of repair as well as severity of cardiogenic shock plays a significant role in determining prognosis.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Management and outcome of post-myocardial infarction ventricular septal rupture—A Low-Middle-Income Country Experience

Aijaz

Peerwani²,

Bugti³

et al. 2022

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Ventricular septal rupture (VSR) is a serious complication after an acute myocardial infarction (MI). The incidence of VSR was 1% to 3% in the era before accessible reperfusion practices [ 1 ]. However, the incidence has declined in recent years to around 0.3% following the emergence of thrombolysis and primary percutaneous coronary intervention (PPCI) [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

One-year outcome and survival analysis of deferred ventricular septal repair in cardiogenic shock supported with mechanical circulatory support

et al. 2021

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Background and objective The effectiveness of deferred surgical repair of ventricular septal rupture (VSR) post-myocardial infarction (MI) with cardiogenic shock remains limited to case reports. Our study aimed to investigate the outcomes and survival analysis following mechanical circulatory support (MCS) in patients after VSR who develop cardiogenic shock. Methods We analyzed 27 patients with post-MI VSR and cardiogenic shock who received deferred surgical repair while stabilized on MCS between January 2018 and March 2020. After normality test adjustments, continuous variables were expressed as mean ± standard deviation (SD). These were compared using the Mann-Whitney U test and Student’s t-test. Categorical variables were compared using chi-square or Fisher’s exact test. To identify predictors of operative mortality, univariate analysis of clinical characteristics and interventions followed by logistic regression was carried out. P-value of < 0.05 was considered significant. Results All patients had preoperative MCS. Emergency repair was avoided in all the patients. The mean age of the participants was 64.96 with the majority being males (74.1%). On average, the mean time from MI to VSR repair was 18.85 days. Delayed revascularization was associated with increased mortality (OR 17.500, 95% CI 2.365–129.506, P = 0.005). Other factors associated with increased mortality were ejection fraction (EF), three-vessel disease, Killip class, early surgery, and prolonged use of inotropes. The operative mortality was 11% with an overall mortality of 33.3%. The one-year survival rate was 66.7%. Conclusion The use of MCS in adjunct to a deferred surgical approach shows an improved survival outcome of patients with VSR complicated by cardiogenic shock. Further investigations are required regarding the optimal time for MCS and surgical repair.

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“…Ventricular septal defects complicating STEMIs are associated with high mortality, prevailing at 50% even after surgical repair [3]. Fatality is significantly higher in patients of advanced age [4].…”

Section: Discussionmentioning

confidence: 99%

Przypadek kliniczny pacjenta z niedokrweinnym ubytkiem w przegrodzie międzykomorowej. Czy istnieje możliwość wyjścia z tego impasu?

et al. 2022

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This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.A case study of post-myocardial infarction ventricular septal defect. Is there always a solution to this deadlock?Przypadek kliniczny pacjenta z niedokrwiennym ubytkiem w przegrodzie międzykomorowej. Czy istnieje możliwość wyjścia z tego impasu?

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Incidence and predictors of 30-day mortality in patients with ventricular septal rupture complicating acute myocardial infarction

Abstract: In this retrospective cohort of patients with AMI, the occurrence of VSR was not rare and carried a considerable risk of 30-day mortality. Advanced age, previous cerebrovascular accident and surgical repair influenced the risk for 30-day mortality.

Cited by 7 publications

References 17 publications

Management and outcome of post-myocardial infarction ventricular septal rupture—A Low-Middle-Income Country Experience

Management and outcome of post-myocardial infarction ventricular septal rupture—A Low-Middle-Income Country Experience

One-year outcome and survival analysis of deferred ventricular septal repair in cardiogenic shock supported with mechanical circulatory support

Przypadek kliniczny pacjenta z niedokrweinnym ubytkiem w przegrodzie międzykomorowej. Czy istnieje możliwość wyjścia z tego impasu?

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