Background: Ventricular septal rupture (VSR) is a serious and fatal mechanical complication of acute myocardial infarction (AMI), once AMI patients are complicated with VSR, the mortality rate is as high as 90%. In this study, we explored the factors affecting the long-term prognosis of VSR patients from many aspects, and evaluated the evaluation performance of multiple scoring systems such as European Heart Surgery Risk Assessment System II (EuroSCORE II).
Methods: This study retrospectively enrolled 188 patients with VSR between Dec 9, 2011 and Nov 21, 2021at First Affiliated Hospital of Zhengzhou University. All patients were followed up until Jan 27, 2022 for clinical data, angiographic characteristics, echocardiogram outcomes, intraoperative, postoperative characteristics and major adverse cardiac events (MACEs) (30-day mortality, all-cause readmissions, recurrent MI, and unstable angina). Cox proportional hazard regression analysis was used to explore the predictors of long-term mortality.
Results: The median age of 188 VSR patients was 66.2±9.1 years and 97 (51.6%) were males. And there were 103 (54.8%) patients in the medication group, 34 (18.1%) patients in the percutaneous TCC group, and 51 (27.1%) patients in the surgical repair group. The average follow-up time was 857.4 days. The long-term mortality of the medically managed group, percutaneous TCC group, and surgical management group was 94.2, 32.4, and 35.3%, respectively. Whether combined with cardiogenic shock (OR 0.023, 95% CI 0.001–0.054, p=0.019), NT-pro BNP level (OR 0.027, 95% CI 0.002–0.34, p=0.005), EuroSCORE II (OR 0.530, 95% CI 0.305–0.918, p=0.024) and therapy group (OR 3.518, 95% CI 1.079–11.463, p=0.037) were independently associated with long-term mortality in patients with VSR. The cutoff point of EuroSCORE II was determined to be 14, and there were statistically significant differences between EuroSCORE II ＜ 14 group and EuroSCORE II≥14 group (HR=0.2596, 95%CI: 0.1800-0.3744, Logrank P＜ 0.001).
Conclusions: The prognosis of VSR patients without operative management remains poor, more research is needed to determine the optimal timing of surgery in patients with VSR to improve clinical outcomes. Moreover, EuroSCORE II could be used as a prognostic factor for VSR patients.