Long-Term Prognosis of Postinfarction Ventricular Septal Rupture: A Single-Center Experience.

Objective: This seven-year study investigates risk factors for long-term mortality in AMI patients with ventricular septal rupture (VSR) to enhance clinical management and outcomes.

Methods: We conducted a retrospective cohort study of 180 AMI patients with VSR from January 2016 to October 2023. We collected data on demographics, clinical features, treatments, and outcomes. Patients were divided into survival and death groups and further classified by treatment (surgical repair vs. medical management). Cox proportional hazards regression identified predictors of long-term mortality.

Results: Median follow-up was 1028 days, with an overall mortality rate of 65.6%. The death group had a higher rate of medical management (83.1% vs. 35.5% in survivors). Long-term mortality rates were 33.3% for surgical repair and 81.7% for medical management. Independent predictors of poor outcomes included Killip Class 3-4, female gender, and advanced age. Surgical repair was a protective factor against mortality (HR 0.232). Killip Class 3-4 (HR 5.154) was a significant independent risk factor for long-term mortality among surgical patients. Killip Class 3-4 (HR, 3.268) and female gender (HR 2.548) were significant independent risk factors for long-term mortality among medical management patients.

Conclusion: Surgical repair significantly reduces long-term mortality compared to medical management in AMI patients with VSR. Killip Class 3-4 affects prognosis, emphasizing the need for tailored management strategies.