Ventricular septal rupture complicating acute myocardial infarction: Incidence, treatment, and outcomes among medicare beneficiaries 1999–2014. Issue 6 (7th March 2018)

• Record Type: Journal Article
• Authors: Goldsweig, Andrew M.; Wang, Yun; Forrest, John K.; Cleman, Michael W.; Minges, Karl E.; Mangi, Abeel A.; Aronow, Herbert D.; Krumholz, Harlan M.; Curtis, Jeptha P.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 92:Issue 6(2018)
• Page Start: 1104
• Page End: 1115
• Publication Date: 2018-03-07
• Subjects: ACS/NSTEMI (ACS) -- closure -- structural heart disease intervention (SHDI) -- VSD (CLVS); Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.27576
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Objectives: The present study was designed to assess whether the incidence and outcomes of VSR‐AMI have changed in the era of timely primary PCI. Background: Ventricular septal rupture (VSR) is a rare but frequently fatal complication of acute myocardial infarction (AMI). Methods: We conducted a retrospective cohort study of all Medicare fee‐for‐service beneficiaries from 1999 to 2014 to examine trends in the incidence, surgical and percutaneous repair, and 30‐day and 1‐year mortality of VSR‐AMI. Results: The annual incidence of VSR‐AMI hospitalization declined by 41.6% from 197 patients per 100, 000 AMIs in 1999 to 115 patients per 100, 000 AMIs in 2014 ( P < 0.001). The 30‐day VSR‐AMI repair rate decreased from 49.9% in 1999 to 33.3% in 2014 ( P < 0.001). In 2014, 82.9% of repairs were performed surgically and 17.1% percutaneously. VSR‐AMI mortality rates were high (60.2% at 30 days; 68.5% at 1 year) and changed minimally over the study period with adjusted 30‐day mortality per year Odds Ratio (OR) 0.99 (95% confidence interval [CI] 0.98–1.01) and adjusted 1‐year mortality per year OR 0.98 (95% CI 0.97–1.00). Across the 16 years of data, unadjusted mortality rates were lower in patients undergoing repair than in unrepaired patients at 30 days (mean 51.7% and 65.7%, P ≤ 0.01) and 1 year (mean 62.0% and 72.8%, P < 0.01). Conclusions: In the era of increased timely primary PCI, the incidence of VSR‐AMI hospitalization declined but its associated mortality rate remained high. Rates of VSR repair decreased from 1999 to 2014 despite increased use of percutaneous repair.