Incidence and In-Hospital Mortality of Ventricular Septal Rupture Following Acute Myocardial Infarction

Ventricular septal rupture (VSR) is a rare but devastating complication of acute myocardial infarction (MI), associated with high mortality despite advances in reperfusion therapy. However, contemporary data examining national trends in VSR outcomes and the evolving role of mechanical circulatory support (MCS) in this population remain limited.

This study aimed to evaluate modern trends in VSR incidence, inpatient mortality, and MCS utilization among patients with MI using a nationally representative database.

We analyzed the Nationwide Inpatient Sample from 2016 to 2021, identifying MI hospitalizations in adults ≥ 40 years. Outcomes included in-hospital mortality (primary), length of stay, adverse disposition, cardiogenic shock (CS), and MCS use (secondary).

Of 5.4 million acute MI admissions, 2605 (0.05%) involved VSR. Patients with VSR experienced significantly higher mortality (49.9% vs. 8.6%), CS (70.1% vs. 6.7%), and greater reliance on MCS (ECMO 4.4% vs. 0.1%, IABP 47.6% vs. 3.2%, LVAD 15.9% vs. 1.2%; all p < 0.001). Regression analysis revealed increased odds of mortality (aOR 4.53, 95% CI 3.41-6.02), prolonged hospitalization, shock, adverse disposition, and MCS use. Across the study period, VSR incidence (0.03%-0.06%), mortality (43%-55%), and MCS rates (53%-68%) remained stable.

Despite advances in cardiovascular care, VSR outcomes in the acute MI setting have not substantially improved. However, the incidence of this mechanical complication has decreased in the contemporary era of early reperfusion and advanced therapies as suggested by our cohort. Use of MCS with MI complicated by VSR remains high, and a nuanced approach for modality selection is necessary, especially in candidates for delayed repair. Trends in VSR incidence, mortality, and MCS remained stable throughout the study period. These findings underscore the persistent challenge in post-MI VSR management and emphasize the need for prospective randomized trials to define optimal repair timing and clarify whether MCS modality selection influences outcomes in this high-risk population.