Clinical study
Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry

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Abstract

OBJECTIVES

We wished to assess the profile and outcomes of patients with ventricular septal rupture (VSR) in the setting of cardiogenic shock (CS) complicating acute myocardial infarction (MI).

BACKGROUND

Cardiogenic shock is often seen with VSR complicating acute MI. Despite surgical therapy, mortality in such patients is high.

METHODS

We analyzed 939 patients enrolled in the SHOCK Trial Registry of CS in acute infarction, comparing 55 patients whose shock was associated with VSR with 884 patients who had predominant left ventricular failure.

RESULTS

Rupture occurred a median 16 h after infarction. Patients with VSR tended to be older (p = 0.053), were more often female (p = 0.002) and less often had previous infarction (p < 0.001), diabetes mellitus (p = 0.015) or smoking history (p = 0.033). They also underwent right-heart catheterization, intra-aortic balloon pumping and bypass surgery significantly more often. Although patients with rupture had less severe coronary disease, their in-hospital mortality was higher (87% vs. 61%, p < 0.001). Surgical repair was performed in 31 patients with rupture (21 had concomitant bypass surgery); 6 (19%) survived. Of the 24 patients managed medically, only 1 survived.

CONCLUSIONS

There is a high in-hospital mortality rate when CS develops as a result of VSR. Ventricular septal rupture may occur early after infarction, and women and the elderly may be more susceptible. Although the prognosis is poor, surgery remains the best therapeutic option in this setting.

Abbreviations

BP
blood pressure
CAD
coronary artery disease
CK
creatine kinase
CS
cardiogenic shock
ECG
electrocardiogram, electrocardiographic
IABP
intra-aortic balloon pump
LV
left ventricular, left ventricle
MI
myocardial infarction
MR
mitral regurgitation
RV
right ventricular, right ventricle
SHOCK
SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK?
TIMI
Thrombolysis In Myocardial Infarction
VSR
ventricular septal rupture

Cited by (0)

Supported by grants RO1 HL50020 and HL49970 (1994–1999) from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.