Abstract

CLINICAL CHARACTERISTICS AND SHORT-TERM OUTCOMES OF POST-MYOCARDIAL INFARCTION VENTRICULAR SEPTAL RUPTURE- A RETROSPECTIVE STUDY

Author(s): Sajeev Govindan Chakanalil, Himanshu Gupta, Dolly Mathew, Kader Muneer, Rajesh Gopalan Nair, Mohanan Kurukkanparampil Sreedharan, Vinayakumar Deshabandu

BACKGROUND We wanted to evaluate the patient characteristics, risk factors, short-term outcomes and predictors of poor outcomes in patients with ventricular septal rupture developed as a complication of acute myocardial infarction. METHODS This was a single-centre, retrospective study which included 45 patients with ventricular septal rupture developed post-acute myocardial infarction, admitted to a tertiary centre in India, between April 2012, and February 2017. Ventricular septal rupture was diagnosed and localized/characterised using echocardiography. The comparison of survivor and non-survivor patients was done for demographic, lesion and procedural characteristics, effect of time of surgery on mortality in patient with ventricular septal rupture. RESULTS The mean age of the patients was 62.5 ± 9.77 years. Anterior wall myocardial infarction and apical location of ventricular septal rupture were present in most of cases. The median time from onset of symptoms to the diagnosis of the ventricular septal rupture was 2 days. The overall 30-days mortality was 80%. Medically treated patients (n =37) had a 30 days mortality of 94.6%. Among surgically treated patients (n=8), the survival at 30 days was 87.5%. Low left ventricular ejection fraction, high TIMI score and shorter duration between the onset of myocardial infarction and occurrence of ventricular septal rupture were found to be associated with poor outcomes and high mortality rate. CONCLUSIONS Despite improvements in medical, surgical as well as interventional techniques, the short-term prognosis of post-myocardial infarction ventricular septal rupture remains poor.