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

Table 5 Comparison of advantages and disadvantages among different treatment strategies

Treatment method	Indications	Success rate (%)	Complications incidence (%)	Cost-effectiveness	Ref.
Percutaneous interventional closure procedure (TCC)	The condition is stable, the perforation diameter is ≤ 20 mm, and the location is away from the valve structures	73.8 (3-year survival rate)	32 (Residual shunt, mechanical hemolysis)	Moderate (requiring high-precision imaging equipment and consumables)	[20,82,193-195]
Surgical repair (combining CABG)	Perforation diameter > 20mm, multivessel disease, combined with ventricular aneurysm or valvular injury	70 (3-year survival rate)	40-52 (Postoperative infection, cardiogenic shock)	Low (The surgical costs are high, requiring long-term monitoring and care)	[98,114,165,169]
Medical conservative treatment (medication + IABP/ECMO)	Hemodynamically extremely unstable, unable to tolerate surgery or interventional therapy	38.5 (30-day survival rate)	50-60 (multiple organ failure, hemorrhage)	Low short-term costs, but high long-term expenses (requires repeated hospitalizations)	[25,165,196]
Delayed intervention closure (occurring > 3 weeks after VSR)	Myocardial edema subsides, hemodynamics stabilize, and perforated tissue becomes fibrotic	96.3 (30-day survival rate)	10-15 (Residual shunt, arrhythmia)	High (reduces the risk of secondary surgery)	[58,82,193,197]
Early intervention and occlusion (VSR occurrence ≤ 3 weeks)	Emergency rescue, unable to wait for delayed surgery	62.5 (30-day survival rate)	45-50 (Perforation enlargement, occluder displacement)	Moderate (urgent resource support required)	[193,198,199]
VA-ECMO combined with IABP support	CS, hemodynamic collapse	40 (Survival rate improvement)	25-30 (Lower limb ischemia, hemorrhage)	Low (equipment and monitoring costs are high)	[169,200,201]
Pharmacological treatment alone (diuretics + vasodilators)	Hospice care or transitional treatment	14.3 (30-day survival rate)	60-70 (Deterioration of renal function, electrolyte imbalance)	Minimum (drug cost only)	[165,202,203]
Interventional occlusion combined with PCI procedure	Single-vessel disease, late-onset VSR after PCI	91.4 (Surgical success rate)	20-25 (Stent thrombosis, residual shunt)	Moderate (requires phased implementation)	[58,194,195]
Surgical procedure combined with CABG	Multivessel disease requiring revascularization, combined with complex anatomical structures	80 (Long-term survival rate)	35-40 (Postoperative infection, stroke)	Low (surgical and rehabilitation costs compounded)	[93,169,204]
Staged interventional therapy (occlusion first followed by PCI)	Hemodynamically stable but requires revascularization	85 (1-year survival rate)	15-20 (Secondary operational risk)	Moderate (phased fee accumulation)	[195,203,205]
Palliative care (anti-heart failure medications)	Advanced age, severe comorbidities, limited life expectancy	-	-	Minimum (only basic medication costs)	[105,119,165]
IABP standalone support	Mild cardiogenic shock, transition to definitive treatment	20 (Survival rate improvement)	15-20 (Lower limb ischemia, catheter infection)	Moderate (equipment rental and monitoring costs)	[118,169,206]
Emergency surgical procedure (≤ 7 days)	Hemodynamically unstable, unable to wait for myocardial repair	57 (30-day survival rate)	50-60 (Postoperative heart failure, infection)	Low (emergency surgery costs and high risk)	[83,111,165]
Delayed surgical procedure (> 4 weeks)	Myocardial tissue stabilization, hemodynamic improvement	93.5 (30-day survival rate)	10-15 (Postoperative adhesions, arrhythmia)	High (surgical success rate improvement)	[112,173,193]
Hybrid surgery (interventional + surgical)	Complex perforations (multiple holes or serpentine tracts), residual shunts requiring secondary intervention	75 (Overall success rate)	30-35 (Multi-stage complication risks)	Low (high cost of multidisciplinary collaboration)	[10,93]
Anticoagulation therapy (heparin/warfarin)	Hypercoagulable state, embolism prevention	-	20-25 (Bleeding, thrombocytopenia)	Low (primarily drug costs)	[82,169,202,207]
Anti-inflammatory therapy (glucocorticoids)	Systemic inflammatory response, significant elevation of CRP	30 (Prognosis improvement rate)	10-15 (Risk of infection increases)	Moderate (requires monitoring of infection indicators)	[106,165,169,208]
Transcatheter thrombolytic therapy	No PCI conditions, early reperfusion requirements	50 (Recanalization rate)	30-40 (Bleeding, allergic reactions)	Low (medication costs are low, but complication treatment expenses are high)	[58,169,209]
Pericardiocentesis drainage	Massive pericardial effusion leading to cardiac tamponade	90 (Symptom remission rate)	5-10 (Puncture injury, infection)	Moderate (requires imaging guidance and aseptic operation)	[116,210]
MELD-XI Score-Guided Therapy	Risk stratification in patients with hepatic and renal dysfunction	-	-	High (optimizing resource allocation and reducing ineffective treatment)	[58,82,83]

TCC: Transcatheter Closure; CABG: Coronary artery bypass graft; IABP: Intra-aortic balloon pump; ECMO: Extraciroireal membrane oxygenation; CS: Cardiogenic shock; PCI: Percutaneous coronary intervention; VSR: Ventricular septal rupture.