Risk factors and predictive model for mortality in acute myocardial infarction with ventricular septal rupture at high altitudes.

Background: Acute myocardial infarction (AMI) combined with ventricular septal perforation (VSR) is still a highly fatal condition in the era of reperfusion therapy. The incidence rate has decreased to 0.2%-0.4% due to the popularization of percutaneous coronary intervention. However, the risk is significantly increased for those who fail to undergo revascularization in time, and the mortality rate remains high. The current core contradiction in clinical practice lies in the selection of surgical timing, and the disparity in medical resources significantly affects prognosis. There is an urgent need to optimize the identification of high-risk populations and individualized treatment strategies.

Aim: To investigate the clinical features, determine the prognostic factors, and develop a predictive model for 30-day mortality in patients with acute myocardial infarction complicated by ventricular septal rupture (AMI-VSR) residing in high-altitude regions.

Methods: This study retrospectively analyzed 48 AMI-VSR patients admitted to a Yunnan hospital from 2017 to 2024, with the establishment of survival (n = 30) and mortality (n = 18) groups based on patients' survival status. Risk factors were identified by univariate and multivariate logistic regression analyses. A nomogram model was developed using R software and validated via receiver operating characteristic (ROC) analysis and calibration curves.

Results: Age, uric acid (UA), interleukin-6 (IL-6), and low hemoglobin (Hb) were independent risk factors for 30-day mortality (odds ratios: 1.147, 1.006, 1.034, and 0.941, respectively; P < 0.05). The nomogram demonstrated excellent discrimination (area under the ROC curve = 0.939) and calibration (Hosmer-Lemeshow χ² = 2.268, P = 0.971). In addition, patients' poor outcomes could be synergistically predicted by IL-6 and UA, advanced age, and reduced Hb.

Conclusion: This study highlights age, UA, IL-6, and Hb as critical predictors of mortality in AMI-VSR patients at high altitudes. The validated nomogram provides a practical tool for early risk stratification and tailored interventions, addressing gaps in managing this high-risk population in resource-limited settings.