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

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.