Author + information
- Vikas Singh1,
- Alexis Rodriguez2,
- Parth Bhatt3,
- Badal Thakkar4,
- Nileshkumar Patel5,
- Mauricio Cohen6,
- Igor Palacios7,
- Ignacio Inglessis8,
- Sammy Elmariah9 and
- William O'Neill10
- 1Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
- 2university of miami miller school of medicine, miami, Florida, United States
- 3Texas Tech University Health Sciences Center, Amarillo, Texas, United States
- 4Rutgers New Jersey Medical School, Newark, New Jersey, United States
- 5University of Miami, MIAMI, Florida, United States
- 6University of Miami Hospital, Miami, Florida, United States
- 7Massachusetts General Hospital, Boston, Massachusetts, United States
- 8Massachusetts General Hospital, Boston, Massachusetts
- 9Massachusetts General Hospital, Boston, Massachusetts, United States
- 10Henry Ford Hospital, Detroit, Michigan, United States
Ventricular septal rupture (VSR) is a sporadic but lethal complication after an acute myocardial infarction (MI). With the advent of reperfusion strategies, VSRs have become all the more infrequent, yet the outcomes continue to negatively impact the clinical prognosis of these patients while remaining a major contributor to their mortality.
We identified patients using the ICD-9CM procedure codes from the Nationwide Inpatient Sample between the years 2001 and 2013. Stata IC 11.0 (Stata-Corp, College Station, TX) and SAS 9.3 (SAS Institute Inc, Cary, North Carolina) were utilized for analyses.
We identified over three million ST-elevation MIs (3,373,206) during the study period out of which 10,012 (0.3%) were complicated with VSRs. Most of the patients (60%) were older than 65 years of age, male (55%), and white (63%). Anterior (41.1%) and inferior (49.7) MIs were the most commonly implicated with the development of VSRs. The median length of hospital stay was 7 days (3.0-13.5) and the cost was $30,039 ($15,109-$62,898). Only 7.65% of patients underwent some form of intervention with 7% surgical and 0.65% minimally invasive. There was a downtrend in the use of surgical intervention being 16.7% in 2001 to 2.3% in 2013. Mechanical support devices were used in 36.5% of patients, with intra-aortic balloon pump (35%) being the most commonly employed. Overall in-hospital patient mortality remained high at 30.5% (downward trend from 41.6% in 2001 to 23.3% in 2013). Age, cardiogenic shock, and in-hospital cardiac arrest were statistically significant predictors of increased in-hospital mortality. The use of mechanical support devices and performing a corrective procedure were associated with higher mortality, length of stay and cost likley due to selection bias of sicker patient population.
VSRs after acute MI are rare but remain associated with significantly high mortality rate. Highly specialized regional centers with individual expertise in management of septal ruptures are required to improve outcomes of these patients.
CORONARY: Acute Myocardial Infarction