Acute myocardial infarction with ventricular septal rupture: Clinical characteristics, prognosis factors, and treatment strategies

Table 2 Comparative table of clinical characteristics of acute myocardial infarction complicated by ventricular septal rupture

Clinical factors	Clinical manifestations	Diagnostic methods	Risk factors	Prevalence (%)	Treatment options	Ref.
Gender	The proportion of females was significantly higher than that in the control group (62.5% vs 36.4%)	Retrospective cohort analysis	Female is an independent risk factor	62.5 (VSR group)	Gender does not affect treatment selection, but women require closer hemodynamic monitoring	[6,105]
Age	Average age 66.85 years (VSR group) vs 60.79 years (control group)	Analysis of clinical data	Advanced age (> 65 years) significantly increases the risk	-	Elderly patients should be prioritized for interventional or surgical procedures	[6,105]
Inflammatory markers	CRP, D-dimer levels are significantly elevated	Serological testing (CRP, D-dimer)	Inflammatory response exacerbates myocardial necrosis	-	Anti-inflammatory therapy (such as glucocorticoids) may assist in stabilizing the condition	[106,107]
Myocardial injury markers	TnT significantly elevated	Troponin test	TnT levels are positively correlated with myocardial necrosis area	-	Early reperfusion therapy reduces peak TnT levels	[108]
Hemoglobin	Hb, Hct, and RBC were significantly lower than those in the control group	Complete blood count test	Anemia may increase the cardiac workload	-	Blood transfusion support to maintain tissue oxygen supply	[14]
Cardiac function classification	Killip classification ≥ grade III (78.1% in the deceased group vs 50% in the survival group)	Killip classification assessment	Deterioration of cardiac function is an independent risk factor for mortality	60 (Killip IV)	IABP support therapy	[25,34]
Myocardial infarction site	Anterior wall myocardial infarction accounts for 75%-84.6%	ECG, echocardiogram	Anterior wall infarction is prone to involve the blood supply area of the interventricular septum	75-84.6	Patients with anterior wall infarction require early screening for VSR	[14,109,110]
Location of ventricular septal perforation	Near the cardiac apex (anterior wall infarction) vs posterior interventricular septum (inferior wall infarction)	Echocardiography (ventricular septal echo dropout, left-to-right shunt)	Posterior perforation carries a worse prognosis	60 near the cardiac apex	Interventional closure is suitable for anterior perforations, while surgical repair is indicated for complex locations	[58]
Perforation diameter	Average 9.8 ± 3.9 mm, large perforation (> 15 mm) are associated with higher mortality rates	Echocardiography	The perforation diameter is positively correlated with the left-to-right shunt volume	-	Major perforations require emergency surgical intervention or occlusion	[10,110]
Reperfusion therapy	The proportion of reperfusion therapy was low (0% in the death group vs 50% in the survival group)	Coronary angiography (IRA completely occluded)	Failure to receive reperfusion therapy increases the risk of VSR	-	Emergency PCI or thrombolysis reduces the incidence of VSR	[10]
Comorbidity	Hypertension (60%); Diabetes (27.8%-46.9%)	Medical history collection	Hypertension and diabetes accelerate myocardial remodeling	60 (hypertension)	Control blood pressure and blood sugar to reduce cardiac workload	[14,110]
Hemodynamic status	CS (90% mortality group vs 33.9% survival group)	Hemodynamic monitoring (mean arterial pressure, heart rate)	CS is an independent risk factor for 30-day mortality. (OR = 24.112)	90 (mortality group)	VA-ECMO or IABP	[14]
Laboratory indicators	Elevated white blood cell count and lactate levels (survival group)	Complete blood count, lactate test	Elevated white blood cell count (OR = 1.619) is associated with mortality	-	Anti-infection and metabolic support therapy	[58]
MELD-XI Score	Patients with a score > 15 had a 3-year survival rate of 35.7% vs 85.1% for those with a score ≤ 15	MELD-XI score (Based on creatinine and bilirubin)	High score indicates hepatic and renal dysfunction with poor prognosis	-	Patients with a score > 15 should be prioritized for palliative care	[58]
Echocardiography parameters	LVEF is normal (66.7% of patients), but cardiac function continues to deteriorate	LVEF, LVEDD measurement	LVEF is normal but mechanical complications are prone to be missed in diagnosis	-	Comprehensive evaluation based on clinical symptoms	[14,93]
Coronary artery disease	Multivessel disease (62.5%), with the left anterior descending artery being the most common infarct-related vessel	Coronary angiography	Multivessel disease and absence of collateral circulation increase the risk of VSR	62.5 (multivessel disease)	CABG combined with VSR repair	[14,110]
Time	Patients with AMI to VSR time ≤ 4 days have higher mortality rates	Medical history review	Early perforation (≤ 4 days) presents fragile myocardial tissue and carries high surgical risks	-	Postpone the surgery for 3-4 weeks (if hemodynamically stable)	[94]
Timing of surgical intervention	Early surgery (≤ 7 days) mortality rate 43%, delayed surgery (> 4 weeks) mortality rate 65%	Analysis of Surgical Records	The timing of surgery is correlated with myocardial tissue stability	-	Hemodynamically stable patients are recommended for delayed surgery	[111,112]
Interventional occlusion procedure	The 30-day mortality rate after occlusion was 32%, with a 3-year survival rate of 73.8%	Percutaneous interventional occlusion (umbrella occluder)	Blockage failure is related to the perforation location and diameter	-	Applicable to patients with hemodynamic stability and suitable perforation site	[58]
Conservative treatment	The mortality rate of conservative treatment was 61.5% vs surgery/intervention at 14.3%	Medications (diuretics, vasodilators, positive inotropic drugs)	Conservative treatment is only suitable for those who cannot tolerate surgery	-	Short-term transitional therapy requires combination with IABP or ECMO	[113]
Merged ventricular aneurysm	30% of patients are complicated by ventricular aneurysm	Echocardiography or cardiac MRI	Ventricular aneurysm increases the risk of cardiac rupture	30	Resection of ventricular wall aneurysm combined with VSR repair	[21]
Renal insufficiency	Elevated serum creatinine (death group 138.5 μmol/L vs survival group 88.0 μmol/L)	Serum creatinine test	Renal insufficiency is an independent risk factor for postoperative mortality (OR = 1.78)	-	Preoperative hemofiltration or postoperative CRRT	[14,114]
Arrhythmia	The incidence of ventricular fibrillation and atrial fibrillation is relatively high	Electrocardiographic monitoring	Arrhythmia reflects instability in myocardial electrical activity	-	Antiarrhythmic drugs or ICDs	[115]
Thrombosis risk	D-dimer levels were significantly elevated (death group 2.2 μg/mL vs survival group 1.0 μg/mL)	D-dimer test	Hypercoagulability increases the risk of embolism	-	Anticoagulation therapy (such as heparin), but the bleeding risk needs to be balanced	[109,116]
Pulmonary artery systolic pressure	Pulmonary arterial hypertension (> 50 mmHg) is associated with right heart failure	Echocardiography (Tricuspid Regurgitation Velocity Method)	Pulmonary hypertension indicates increased right heart workload	-	Reduce pulmonary circulation resistance (such as inhaling NO)	[58,117]
Mitral regurgitation	Mitral regurgitation area shows no significant correlation with mortality	Echocardiography (regurgitant jet area measurement)	Mitral regurgitation is mostly secondary and not an independent risk factor	-	After VSR repair, mitral valve function can be indirectly improved	[118]
Hospitalization period	The death group had a shorter hospital stay (6 days vs the survival group's 22.5 days)	Medical record analysis	Short-term hospitalization reflects a sharp deterioration in the condition	-	Short-term hospitalization reflects a sharp deterioration in the condition	[6,109]
Long-term prognosis	3-year survival rate: Interventional closure 738%, surgical procedure 70%	Follow-up (survival rate, cardiac function classification)	Long-term mortality is often due to heart failure or reinfarction	-	Long-term anti-heart failure therapy postoperatively (such as ARNI, β-blockers)	[6,119]
Case distribution	VSR accounts for approximately 0.2%-1.57% of AMI	Epidemiological statistics	The incidence of VSR has decreased in the PCI era, but mortality rates remain high	0.2 - 1.57	Enhance the popularization rate of early reperfusion therapy to reduce the incidence rate	[98,110]

AMI: Acute myocardial infarction; CRP: C-reactive protein; TnT: Troponin T; Hct: Hematocrit; RBC: Red blood cell count; IABP: Intra-aortic balloon pump; ECG: Electrocardiogram; IRA: Infarct-related artery; PCI: Percutaneous coronary intervention; CS: Cardiogenic shock; VA-ECMO: Venous-arterial extracorporeal membrane oxygenation; LVEF: Left ventricular ejection fraction; LVEDD: Left ventricular end-diastolic diameter; CABG: Coronary artery bypass graft; CRRT: Continuous renal replacement therapy; ICDs: Implantable cardioverter defibrillators; NO: Nitric oxide; ARNI: Angiotensin receptor neprilysin inhibitor; VSR: Ventricular septal rupture.