Relationship between Complete Revascularization and Survival after Post-Infarction Ventricular Septal Rupture

A well-known and fatal complication of myocardial infarction (MI) is post-infarction ventricular septal rupture (VSR). The benefits and risks associated with coronary angiography and subsequent coronary artery bypass grafting in these patients have sparked controversy. The aim of this study was to determine the outcome of revascularization following MI.

Patients aged between 55 and 78 years were considered for the post-infarction ventricular septal rupture from 2011 to 2017. Factors such as age, sex, anthropometric measurements, systolic and diastolic blood pressure (SBP and DBP), and biochemical parameters like CPK-MB, cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides were measured using standard methods.The estimated Glomerular Filtration Rate (eGFR), a measure of kidney function, was also determined. Additionally, coronary angiographic factors including ECG changes, left ventricular (LV) systolic function, right ventricular (RV) function, Pulmonary Artery Pressure (PAP), proximal coronary lesions in VSR, systolic PAP, Right Atrial Pressure (RAP), and mortality rate were determined.

The study enrolled a total of 81 patients who had been surgically treated for post-infarction VSR. These patients were divided into two groups: survivors (n=35) and non-survivors (N=41). The mean systolic and diastolic blood pressure was higher in the survivor group (115.3 ± 18.7 vs. 96.3 ± 25.3 and 74.6 ± 12.2 vs. 61.2 ± 19.0, P=0.001). PCI was performed in 2.9% of survivors and 9.8% of non-survivors. Angiographic data revealed that 17 (33%) and 33 (63%) patients had single and multiple coronary artery diseases, respectively. CPK-MB levels were significantly higher in the non-survivors group (P<0.05). Echocardiographic findings, including LV ejection fraction, RV ejection fraction, systolic PAP, and the anatomic location of VSR, did not significantly differ between survivors and non-survivors.

Based on these findings, it is recommended to avoid complete revascularization during surgical repair of post-infarction ventricular septal rupture, as it would not improve the outcome.