Temporal trends in postinfarction ventricular septal rupture: the CIVIAM Registry

Postinfarction ventricular septal rupture is a rare but severe complication of myocardial infarction with high mortality rates. Our goal was to analyze which factors could have an impact on mortality due to this entity over the past decade, including those related to mechanical circulatory support....

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Published in:Revista española de cardiología (English ed.) 2021-09, Vol.74 (9), p.757-764
Main Authors: Sánchez Vega, Juan Diego, Alonso Salinas, Gonzalo Luis, Viéitez Flórez, José María, Ariza Solé, Albert, López de Sá, Esteban, Sanz Ruiz, Ricardo, Burgos Palacios, Virginia, Raposeiras-Roubín, Sergio, Gómez Varela, Susana, Sanchis, Juan, Silva Melchor, Lorenzo, Martínez-Seara, Xurxo, Malagón López, Lorena, Zamorano Gómez, José Luis, Sanmartín Fernández, Marcelo
Format: Article
Language:eng ; spa
Subjects:
Acute myocardial infarction
Cardiogenic shock
Complicaciones mecánicas
Comunicación interventricular
Infarto agudo de miocardio
Mechanical complications
Shock cardiogénico
Ventricular septal rupture
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Summary:Postinfarction ventricular septal rupture is a rare but severe complication of myocardial infarction with high mortality rates. Our goal was to analyze which factors could have an impact on mortality due to this entity over the past decade, including those related to mechanical circulatory support. The CIVIAM registry is an observational, retrospective, multicenter study carried out in Spain. We designed a comparative analysis, focused on description of in-hospital management and in-hospital and 1-year total mortality as the primary endpoints, dividing the total observation time into 2 equal temporal periods (January 2008 to June2013 and July 2013 to December 2018). We included 120 consecutive patients. Total mortality during this period was 61.7% at 1-year follow-up. Patients in the second period were younger. One-year mortality was significantly reduced in the second period (75.6% vs 52.7%, P=.01), and this result was confirmed after adjustment by confounding factors (OR, 0.40; 95%CI, 0.17-0.98). Surgical repair was attempted in 58.7% vs 70.3%, (P=.194), and percutaneous closure in 8.7% and 6.8%, respectively (P=.476). Heart transplant was performed in 1 vs 5 patients (2.2% vs 6.8%, P=.405). The main difference in the clinical management between the 2 periods was the greater use of venoarterial extracorporeal membrane oxygenatiom in the second half of the study period (4.4% vs 27%; P=.001). Postinfarction ventricular septal rupture still carries a very high mortality risk. There has been a progressive trend to increased support with venoarterial extracorporeal membrane oxygenatiom and greater access to available corrective treatments, with higher survival rates. La rotura de septo interventricular tras un infarto es una complicación rara, pero muy grave, con una alta tasa de mortalidad. Nuestro propósito es analizar qué factores han podido influir en la mortalidad por esta afección durante la última década, incluyendo los relacionados con la asistencia circulatoria mecánica. El registro CIVIAM es un estudio retrospectivo, observacional y multicéntrico desarrollado en España. Se diseñó un análisis comparativo, cuyos objetivos primarios son describir el tratamiento de esta afección, así como los cambios en la mortalidad hospitalaria y al año, dividiendo el periodo de observación en 2 periodos iguales (enero de 2008 a junio de 2013 y julio de 2013 a diciembre de 2018). En total se reclutó a 120 pacientes consecutivos. La mortalidad total al año fue del 61,7
ISSN:1885-5857
1885-5857
DOI:10.1016/j.rec.2020.07.010