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

Table 4 Analysis of the Association between major prognostic factors and clinical outcomes

Prognostic factors	Clinical impact	Evidence-based basis	Severity level	Management strategies	Timeframe of impact	Population specificity	Intervention efficacy (%)	Ref.
Female	The 30-day mortality rate among female patients showed a significant increase (OR = 4.263)	Multicenter studies indicate that female patients account for 62.5% of VSR cases and represent an independent risk factor	High	Close hemodynamic monitoring with priority given to surgical intervention	Short-term (≤ 30 days)	Female, Elderly patients	The surgical survival rate has increased to 70%	[7,13,163,164]
Age > 65 years old	The mortality rate among elderly patients increased significantly (mean age of survival group: 57.4 years vs death group: 72.4 years)	Logistic regression analysis showed that age was an independent risk factor for 30-day mortality. (OR = 4.956)	High	Elderly patients are recommended to delay surgery (if stable) or undergo interventional occlusion	Short-term to medium-term (≤ 1 year)	Elderly patients	Delayed surgery mortality rate drops to 6.5%	[13,165-168]
Killip Class ≥ Ⅲ	The mortality rate reaches 78.1% in patients with deteriorating cardiac function (death group vs 50% survival group)	Killip classification ≥ grade III is significantly associated with 30-day mortality rate. (OR = 24.112)	Critical	IABP or VA-ECMO support, early surgical intervention	Short-term (≤ 30 days)	Merge patients with cardiogenic shock	IABP support increases survival rate by 20%	[13,20,119,165]
Anterior Wall AMI	Anterior wall infarction patients account for 75%-84.6% of VSR cases, with a higher mortality rate	Anterior wall infarction is prone to involve the blood supply area of the interventricular septum, increasing the risk of perforation. (P = 0.023)	High	Early screening for VSR, prioritizing PCI or CABG combined with repair surgery	Acute phase to short term	Patients with anterior wall AMI	PCI reduces mortality rate to 14.3%	[13,163,169-171]
VSR Diameter > 15 mm	The mortality rate of patients with large perforations (> 15mm) significantly increases	The diameter of the perforation is positively correlated with the left-to-right shunt volume, and large perforations require emergency surgery	Severe	Emergency surgical repair or interventional closure	Acute phase (≤ 7 days)	Hemodynamically unstable patient	The success rate of the occlusion procedure is 73.8%	[13,105,169,172]
Time to VSR Onset ≤ 4 Days	The 30-day mortality rate reaches 77.4% for patients who develop VSR within 4 days after AMI	Early perforation (≤ 4 days) presents with fragile myocardial tissue and carries high surgical risks. (OR = 12.646)	Critical	Postpone surgery until 3-4 weeks later (if stable), supplemented with mechanical circulatory support	Short-term (≤ 30 days)	Early-stage perforation patients	Delayed surgery mortality rate 65%	[6,13,163]
Elevated Inflammatory Markers	Elevated CRP and D-dimer levels are positively correlated with mortality (CRP 85 mg/L in the deceased group vs 27 mg/L in the survival group)	Inflammatory response exacerbates myocardial necrosis, and elevated CRP is associated with mortality (P < 0.05)	Moderate to High	Anti-inflammatory therapy (such as glucocorticoids), infection control	Short-term to medium-term	Patients with concurrent infections or systemic inflammation	Anti-inflammatory therapy improves prognosis by 30%	[13,166,173]
Cardiogenic Shock (CS)	The 30-day mortality rate for patients with combined CS reaches 90%	CS is an independent risk factor (OR = 4.288), requiring VA-ECMO support	Critical	VA-ECMO combined with IABP for hemodynamic maintenance	Acute phase (≤ 7 days)	Patients with hemodynamic collapse	ECMO support increases survival rate by 40%	[13,21,166,174]
LVEF < 40%	Patients with low LVEF showed significantly higher mortality (survivor group LVEF 45% vs deceased group 30%)	Left ventricular dysfunction exacerbates shunting, leading to multiple organ failure	High	Positive inotropic drugs combined with mechanical support to optimize cardiac function before surgery	Medium-term (≤ 1 year)	Patients with chronic heart failure	Postoperative survival rate 70%	[13,169,175]
No ventricular aneurysm	Patients without ventricular aneurysms have a higher mortality rate (OR = 12.646)	Ventricular aneurysm may alleviate perforation tension, while non-aneurysmal myocardium is prone to secondary rupture	Moderate	Ventricular aneurysm resection combined with VSR repair surgery	Long-term (> 1 year)	Patients with complex anatomical structures	Combined surgery survival rate 85%	[163,169,176]
Elevated TnT levels	TnT levels were positively correlated with mortality (3.56 ng/mL in the deceased group vs 0.31 ng/mL in the survival group)	Elevated TnT indicates extensive myocardial necrosis and poor prognosis (P = 0.011)	High	Early reperfusion therapy reduces peak TnT levels	Acute phase (≤ 72 hours)	Patients with extensive myocardial infarction	Reperfusion therapy reduces mortality by 50%	[13,165,177,178]
Delayed surgical timing	Early surgery (≤ 7 days) mortality rate 43% vs delayed surgery (> 4 weeks) 6.5%	The success rate of surgery is higher after myocardial tissue edema subsides	Moderate to High	Hemodynamically stable patients are recommended for delayed surgery, supplemented with temporary mechanical support	Mid-term (1-4 weeks)	Patients with stable condition	Delayed surgery survival rate 935%	[179,180]
Multiple coronary artery diseases	The mortality rate increased in patients with multivessel disease (62.5% vs single-vessel disease)	Multiple vessel disease leads to aggravated myocardial ischemia, making repair more difficult	High	CABG combined with VSR repair surgery	Long-term (> 1 year)	Patients with complex coronary artery lesions	CABG combined surgery survival rate 80%	[13,166,181,182]
Anemia (Hb < 10 g/dL)	Anemia increases cardiac workload and elevates mortality rates (survivor group Hb 12 g/dL vs deceased group 9 g/dL)	Low Hb reduces tissue oxygen supply and accelerates the progression of heart failure	Moderate	Blood transfusion support to maintain Hb > 10 g/dL	Short-term to medium-term	Patients with chronic kidney disease or bleeding tendency	Blood transfusion improves oxygen delivery with a 25% increase in survival rate	[13,99,183]
Renal insufficiency	Postoperative mortality rate increases in patients with renal insufficiency (OR = 1.78)	Elevated creatinine levels (> 138.5 μmol/L) are associated with postoperative mortality	High	Preoperative hemofiltration, postoperative CRRT support	Short-term to long-term	Patients with chronic kidney disease	CRRT support reduces mortality rate by 20%	[6,13,16]
Elevated Lactate Levels	A lactate level > 4 mmol/L indicates tissue hypoperfusion and is associated with significantly increased mortality	Elevated lactate levels reflect systemic hypoperfusion and are associated with multiple organ failure (P < 0.001)	Critical	Optimize perfusion (e.g., ECMO), correct metabolic acidosis	Acute phase (≤ 24 hours)	Patients with shock or sepsis	ECMO support increases survival rate by 35%	[13,166,184,185]
Diabetes Mellitus	Mortality rate increased in patients with combined diabetes (46.9% vs non-diabetic 27.8%)	Diabetes accelerate myocardial remodeling and impair healing (P < 0.05)	Moderate	Strictly control blood glucose (target HbA1c < 7%)	Long-term (> 1 year)	Diabetic patients	Blood sugar control reduces complication rates by 30%	[13,15,186]
Lack of Reperfusion Therapy	The mortality rate reaches 66.7% in patients who did not receive reperfusion therapy	Reperfusion therapy reduces the incidence of VSR (50% of the survival group received PCI vs 0% in the deceased group)	High	Emergency PCI or thrombolysis to restore coronary blood flow	Acute phase (≤ 12 hours)	AMI patients without contraindications	PCI reduces mortality rate to 14.3%	[13,169,187,188]
Postoperative CAR ≥ 2.83	Postoperative CAR is associated with increased risk of complications (OR = 5.540)	CAR predicts postoperative infections and organ failure (AUC = 0.767)	Moderate	Postoperative monitoring of CAR, early anti-infection and nutritional support	Short-term (≤ 30 days)	Postoperative patient	The complication rate decreased by 40% after intervention	[165,189,190]
Genetic Polymorphisms	Specific genotypes (such as IL-6 variants) are associated with exacerbated inflammatory responses	Preliminary studies suggest that gene polymorphisms influence the efficacy of anti-inflammatory therapy (further verification required)	Low to Moderate	Personalized anti-inflammatory regimen	Long-term (> 1 year)	Genetically susceptible population	Research phase, no definitive data available yet	[191,192]

IABP: Intra-aortic balloon pump; VA-ECMO: Venous-arterial extracorporeal membrane oxygenation; CABG: Coronary artery bypass graft; PCI: Percutaneous coronary intervention; CRP: C-reactive protein; CS: Cardiogenic shock; LVEF: Left ventricular ejection fraction; TnT: Troponin T; CRRT: Continuous renal replacement therapy; CAR: C-reactive protein to albumin ratio; IL: Interleukin; Hb: Hemoglobin; AMI: Acute myocardial infarction; VSR: Ventricular septal rupture; OR: Odds ratio.