Objective We sought to investigate the incidence and predictors of 30-day mortality associated with ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI) in a cohort of patients admitted to a single centre in India.
Methods From October 2013 to February 2016, a total of 6560 patients with a diagnosis of AMI were admitted to our institution. Among these patients, those with a diagnosis of VSR were retrospectively included in this registry. Clinical and echocardiographic features were collected in all cases. The primary outcome was 30-day mortality. A Cox proportional hazard regression analysis explored the predictors of 30-day mortality.
Results During the observation period, a total of 51 consecutive patients (mean age 63.8 years (9.1); 51.0% male, 41.2% were patients with diabetes) with a diagnosis of VSR complicating AMI were included. On echocardiography, left ventricular ejection fraction was 42.5% (6.5), and the most frequent location of VSR was apical (78.4%). Overall, 27.4% of the patients received reperfusive therapy (pharmacological, 23.5%; mechanical, 3.9%) and 19.6% of the patients underwent surgical repair. The mean time to surgery was 7.7 days (2.4). At 30-day follow-up, death occurred in 80.4% of patients. Advanced age (HR 1.07, 95% CI (1.02 to 1.13), p=0.004), previous cerebrovascular accident (HR 52.2, 95% CI (3.98 to 685.06), p=0.003) and surgical repair (HR 0.05, 95% CI (0.01 to 0.26), p<0.001) were effect modifiers of the 30-day risk of death.
Conclusions 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.
- acute myocardial infarction
- ventricular septal rupture
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Contributors All the authors played their part in the build-up of this collaborative research project. AP conceived the idea and NJ prepared the draft protocol. Subsequently, PV and GC pitched in for data collection, and the process was completed over years of collective effort. When the datasheet was ready, SCa and RS began data analysis with PV and AP. After the completion of data interpretation, GC was roped in again for drafting the article. Then it was upon the trio of VSN, SKD and SCh to critically review the article and send back to RS. RS initiated the final discussions with NJ, SCa and AP to come out with the final version of the article. The first version was submitted by NJ, but since he had relocated the revised version was submitted by RS in consultation with SCa and AP. SCa was pivotal in revising the article and giving point-by-point rebuttal. AP reviewed the revised version and submitted back the same online. The second revision was done by SCa and AP, guided by RS. Final revision was completed by SCa, while AP reviewed and submitted it online. Conception or design of the work: AP, NJ. Data collection: NJ, AP, PV, GC. Data analysis and interpretation: SCa, RS, PV, AP. Drafting the article: SCa, RS, AP, GC. Critical revision of the article: VSN, SKD, SCh, RS. Final approval of the version to be published: SCa, NJ, AP, RS. Manuscript submission and revision: SCa, RS, AP. Second revision: SCa, AP, RS. Third revision: SCa, AP.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
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