Format

Send to

Choose Destination
Catheter Cardiovasc Interv. 2018 Mar 7. doi: 10.1002/ccd.27576. [Epub ahead of print]

Ventricular septal rupture complicating acute myocardial infarction: Incidence, treatment, and outcomes among medicare beneficiaries 1999-2014.

Author information

1
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
2
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Center for Outcomes Research and Evaluation, New Haven, Connecticut.
3
Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts.
4
Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.
5
Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut.
6
Division of Cardiovascular Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
7
Lifespan Cardiovascular Institute, Providence, Rhode Island.
8
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.
9
Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.

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.

KEYWORDS:

ACS/NSTEMI (ACS); VSD (CLVS); closure; structural heart disease intervention (SHDI)

PMID:
29513365
DOI:
10.1002/ccd.27576

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center