In 1875, Latham et al.1 first described ischemic ventricular septal rupture (VSR) and since then it has been considered one of the most serious complications of acute myocardial infarction (AMI). Currently, the epidemiology of VSR has changed with a prevalence of 0.2% to 0.3%, in comparison with the estimated 3% rates before widespread reperfusion therapies.2, 3, 4 However, survival in affected patients does not appear to have improved. Contemporary registries show extraordinarily high 30-day
This observational, retrospective and multicenter compared differences in the treatment and prognosis of patients with post-AMI VSR during the last decade.
After the study was approved by institutional review boards, we selected all consecutive patients with post-AMI VSR between January 1, 2008, and December 31, 2018 from each local database. An invitation was sent to 11 tertiary hospitals in Spain, located in different geographical regions and with available organized reperfusion networks. Each
A total of 120 patients fulfilled the inclusion criteria, 46 in the first period and 74 in the second period. The estimated incidence of VSR during the study period varied among centers, ranging 0.27% to 0.46% of the full AMI spectrum.
Baseline characteristics are listed in table 1. There were no significant differences between classic cardiovascular risk factors. Patients in the second period were younger. There were no significant differences in previous cardiovascular history between the 2
The main results of our study were the following: a) VSR is still a relatively rare complication of AMI with a high mortality rate; b) VSR patients have been more frequently managed with VA-ECMO support in the last few years, with a trend to more frequent successful achievement surgical repair or heart transplant; c) there is a temporal trend of increased 1-year survival, although in-hospital mortality rates are still higher than 50%.
Despite all current advancements in AMI treatment, mortality
Post-AMI VSR still carries high in-hospital and 1-year mortality. There is a temporal trend toward a decrease in the mortality of post-AMI VSR that appears to be multifactorial. Management differences among 2 time periods included an increase in use of VA-ECMO support and in heart transplant as a possible alternative in anecdotal cases. The contribution of VA-ECMO to overall survival should be addressed in appropriate clinical trials.
The authors received no financial support for the research, authorship, and/or publication of this article.
M. Sanmartín Fernández developed the original project and the hypothesis along with the design and objectives and revised the final manuscript. J.D. Sánchez Vega, G.L. Alonso Salinas, J.M. Viéitez Flórez and J.L. Zamorano Gómez contributed to the analyses of the data and writing of the manuscript. The rest of the authors, including those already listed, contributed to the recruitment process. All authors critically revised the article for important intellectual content and have contributed to
The authors declare no competing interests.
Collaboration in data collection: Nagore Horrillo Alonso and Jorge Díaz Calvo from Hospital Universitario de Cruces (Baracaldo), Sandra Rosillo from Hospital Universitario la Paz, IDIPAZ, Madrid. VSR following a myocardial infarction is a rare but severe mechanical complication with a high mortality rate. Urgent surgery is the treatment of choice but carries a high mortality rate and appropriate timing is challenging. Some patients are managed with mechanical circulatory support as bridge therapyWHAT IS KNOWN ABOUT THE TOPIC?
