Early thrombolysis is associated with decreased operative mortality in postinfarction ventricular septal rupture.
BACKGROUND
Post myocardial infarction ventricular septal rupture (PMI-VSR) is a dreaded mechanical complication of acute coronary syndromes. Given that surgical mortality approaches 50%, it is pragmatic that the risk factors for mortality and outcomes after surgical correction of PMI- VSR are carefully scrutinized.


METHODS
We performed a single-center, retrospective cohort study of 35 patients presenting for surgical closure of post myocardial infarction ventricular septal rupture over six years. We reviewed patient characteristics, clinical, echocardiographic, angiographic and perioperative risk factors which may affect mortality after surgical repair of PMIVSR and 30 day and one year mortality rates of these patients. Univariate and multivariate logistic and cox proportional hazard regression analysis was used to identify predictors of operative and overall mortality. Long term survival was presented with Kaplan-Meier Survival Curve.


RESULTS
Sixteen patients (46%) were in cardiogenic shock. Concomitant coronary artery bypass grafting (CABG) was done in 22 patients (63%) but did not influence survival. Preoperative thrombolysis was done in 12 patients (34%) out of which 10 (53%) survived Operative mortality was 46% and one-year mortality was 49%. Multivariate analysis identified preoperative thrombolysis: Hazards ratio, 0.12; 95% CI, 0.02-0.61; p value of 0.01, as significant independent predictor of survival in PMIVSR cohort.


CONCLUSIONS
Preoperative thrombolysis is associated with decreased odds of operative and overall mortality after surgical repair in PMIVSR patients.
['Dogra|Neeti|N|', 'Puri|Goverdhan Dutt|GD|', 'Thingnam|Shyam K S|SKS|', 'Arya|V K|VK|', 'Kumar|Bhupesh|B|', 'Mahajan|Sachin|S|', 'Verma|Madhur|M|']
D000368:Aged D001026:Coronary Artery Bypass D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D009203:Myocardial Infarction D011183:Postoperative Complications D011300:Preoperative Care D012189:Retrospective Studies D012307:Risk Factors D012770:Shock, Cardiogenic D015912:Thrombolytic Therapy D016896:Treatment Outcome D018658:Ventricular Septal Rupture
Early thrombolysis Ventricular septal rupture Risk factors Outcomes Post–myocardial infarction