The Short-term Outcomes and Risk Factors of Post-myocardial Infarction Ventricular Septal Rupture: a Multi-center Retrospective Study

The Short-term Outcomes and Risk Factors of Post-myocardial Infarction Ventricular Septal Rupture: a Multi-center Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Short-term Outcomes and Risk Factors of Post-myocardial Infarction Ventricular Septal Rupture: a Multi-center Retrospective Study Wenjian Luo, Li Wen, Jinning Zhang, Junyong Zhao, Zelan Wang, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4625058/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Oct, 2024 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted 9 You are reading this latest preprint version Abstract Objectives Post-myocardial infarction ventricular septal rupture (PIVSR) is one of the most severe types of mechanical complications after acute myocardial infarction (AMI) with high mortality and poor prognosis. The risk factors for short-term mortality of patients with PIVSR may be not widely recognized. We aimed to assess the prevalence and short-term mortality risk predictors of PIVSR. Methods A total of 62 patients with a diagnosis of PIVSR were admitted to three top general public hospitals in Chongqing, China. Clinical characteristics and short-term outcomes of patients with PIVSR were compared. Predictors of PIVSR were assessed using logistic regression analysis. Results Mean age was 70.7 ± 10.7 years (38.7% female). The overall in-hospital mortality of PIVSR remained high (71%). Most (47/62) of the patients were in Killip class III or IV at the time of rupture diagnosis. Logistic regression analysis revealed that white blood cell count (WBC, OR 1.619, 95% CI 1.172–2.237, P = 0.005), cardiogenic shock (OR 47.706, 95%CI 2.859-795.945, P = 0.007) and left ventricular ejection fraction (LVEF, OR 0.803, 95%CI 0.689–0.936, P = 0.009) were independent risk factors of in-hospital early mortality. The nomogram developed for predicting the risk of short-term mortality showed a robust discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.956 (95%CI 0.912-1.000). Conclusion The short-term mortality of PIVSR remained high. WBC, cardiogenic shock, and LVEF were the independent predictive factors of short-term mortality. Our nomogram might be used to predict early mortality of patients with PIVSR. Risk factor post-infarction ventricular septal rupture early mortality Figures Figure 1 Figure 2 Figure 3 Introduction Post-infarction ventricular septal rupture (PIVSR) is one of the most severe types of mechanical complications after acute myocardial infarction (AMI), which has high mortality and poor prognosis [ 1 – 5 ] . And if left untreated, it is almost inevitably fatal [ 6 ] . Currently, improvements in revascularization, including pharmacological, catheter-based and surgical, have resulted in improved outcomes for patients with AMI [ 1 , 6 , 7 ] , but in-hospital mortality of this mechanical complication after AMI remained still as high as 60% and the prognosis has not improved over the past 2 decades [ 8 – 10 ] , derived from the unavoidable remodeling based on a large amount of infarcted myocardium. Early diagnosis and risk stratification are crucial to improving outcomes [ 5 ] . However, studies on this disease in recent years are still limited, mainly because of the rarity for this disease [ 11 , 12 ] . Moreover, most of the previous studies came from single-center studies or case reports [ 11 , 13 – 16 ] , which would limit further explorations for better clinical management of PIVSR. Crenshaw BS et al. had identified risk factors associated with increased mortality in patients who developed PIVSR [ 17 ] . Thus, identifying robust predictors of the early mortality might help clinical decision and improve the prognosis of this population, which would be a meaningful way to improve the current complex situation. Based on these, we conducted this present real-world multi-center observational study to evaluate the mortality of PIVSR and try to identify the risk predictors for early mortality, and then provide some information regarding the management of such patients [ 18 ] . Methods This was a multi-center, retrospective registry designed to reflect the “real world” clinical practice since 2013. The primary data were extracted from the electronic medical or archived records by trained staff. Standardized definitions for all patient-related variables and clinical diagnoses were used. Participant data had been anonymized and had not distorted the scholarly meaning. Data source and population From June 2013 to December 2022, we retrospectively studied patients hospitalized for PIVSR at the Second Affiliated Hospital of Army Medical University, the First Affiliated Hospital of Army Medical University and the First Affiliated Hospital of Chongqing Medical University, Chongqing, China. The inclusion criteria for this study were as follows: (1) Age > 18 at inclusion; (2) With the evidence of left-to-right shunt in ventricular septal based on the ultrasonic cardiogram; (3) Definitely diagnosed as AMI, including ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI). The diagnosis of AMI was based on typical clinical symptoms, electrocardiographic findings of ST elevation 0.1mV in more than two limb leads or > 0.2mV in two or more contiguous precordial leads, as well as cardiac enzyme elevation. The exclusion criteria for this study were as follows: (1) Ventricular septal defect caused by congenital heart disease or traumatic heart injury rather than caused by AMI; (2) Patients with malignant tumors or end-stage diseases; (3) No confirmation of the ultrasonic cardiogram; (4) Patients with the ambiguous time for AMI. Finally, 62 patients were included in the study (Fig. 1 ). During the retrospective screening of the medical records, the baseline and procedural characteristics of enrolled patients were collected for further analyses, as well as the relevant laboratory data. Acute & Sub-acute type was defined as being present PIVSR within 72 hours, and late type was defined as being present PIVSR more than 72 hours. The diagnosis of diabetes mellitus are based on the standards of medical care in diabetes mellitus(2019) issued by The American Diabetes Association (ADA) [ 19 ] . The 2018 ESH/ESC guidelines for the management of arterial hypertension are referred to the diagnosis of hypertension [ 20 ] . All enrolled patients were divided into the survival group or the non-survival group based on whether death occurred within 30 days after diagnosis of PIVSR. Statistical analysis Baseline characteristics and clinical outcomes were expressed as number, percentage, or mean and standard deviation (SD) as appropriate. Numerical variables would be shown as median and interquartile range (IQR) values if the data were not normal distribution. categorical variables in the survival group and the non-survival group were compared using Fisher’s exact or chi-square test. Student’s test or Wilcoxon rank-sum test was performed for analyzing continuous data as appropriate. P values were 2-tailed, and P < 0.05 was statistically significant unless otherwise indicated. We used the multiple imputation method in the MICE R package to fill in missing data. Then the univariable logistic regression was used for screening predictors of mortality. The multivariate logistic regression model was established using these variables. The values are related to a significant difference (P < 0.10) in the univariable logistic regression model and a significant difference (P < 0.05) in the multivariable regression model. And multicollinearity was evaluated by variable inflation factors (VIF). The AUC, sensitivity and specificity were used to evaluate the model’s performance. Finally, the nomogram was plotted using the R package “rms”. The calibration C index (bootstrap resampling 1,000 times), the calibration curve (relationship between observation probability and prediction probability), Hosmer Lemeshow goodness of fit test (HL test), and brier score were used to evaluate the degree of consistency between observed and predicted outcomes. Decision curve analysis (DCA) was used to assess the net clinical benefit [ 21 ] . All analyses were performed using R language (version 4.2.1). Results 1.Baseline Comparison between the Two Groups. Only 18 patients survived in the first month and got discharged successfully, showing high mortality of PIVSR (71.0%) (Fig. 1 ). Of all the patients, mean age was 70.7 ± 10.7 years (38.7% female), 25.8% of patients (16/62) had hyperlipidemia, 43.5% of patients (27/62) had hypertension, 30.6% of patients (19/62) had diabetes mellitus, and the patients who had the history of ACS accounted for 16.1%. Most (n = 47 [75.8%]) of the patients were in Killip class III or IV at the time of rupture diagnosis. All the patients enrolled were diagnosed as STEMI. The baseline between the two groups were generally consistent and showed no statistical significance. Patients in the survival group were more likely to be a higher level of LVEF, but more likely to have a lower level of Serum glucose, Cardiac troponin I and WBC count. More details about the patients with PIVSR are shown in Table 1 . Table 1 Baseline characteristics of patients with PIVSR. Parameter Overall (n = 62) Survival (n = 18) Non-Survival (n = 44) p-value Age, year Male, % 70.7(10.70) 38 (61.3) 68.4(7.35) 11 (61.1) 71.61(11.75) 27 (61.4) 0.199 1.000 BMI, kg/m 2 Respiratory Rate HR SBP, mmHg DBP, mmHg Killip Ⅲ/Ⅳ class, % Hypertension, % Hyperlipidemia, % History of CAD, % Current smoker, % Current drinker, % LVEF, % LVEDD, mm Hemoglobin, g/L Log NT-pro BNP CTn I, mmol/L CK-MB, IU/L LDH, IU /L Serum glucose, mmol/L Creatinine umol/L WBC, 10 6 /L TG, mmol/L HDL, mmol/L LDL, mmol/L TC, mmol/L 22.42(3.24) 20.0(18.3–22.8) 95.5(82.3-109.5) 101.5(92.0-124.8) 70.3(16.10) 47 (75.8) 27 (43.5) 16(25.8) 10 (16.1) 15 (24.19) 13 (20.97) 56.0(50.0–61.0) 50.68(5.50) 123.72(20.43) 3.16(2.84–3.63) 1.74(0.05–15.18) 3.82(1.08–41.93) 742.20(321.5-2001.5)8.04(6.30-10.51) 107.5(79.15-148.72) 11.43 (7.95–16.36) 1.08 (0.86–1.55) 0.94 (0.74–1.26) 2.34 (1.81–3.13) 3.65 (3.29–4.65) 22.86(3.55) 20.0(18.3–20.0) 90.0(82.0-101.5) 121.5(98.0-126.5) 75.3(10.11) 14 (77.8) 7 (39.0) 5(27.8) 5 (27.8) 2 (11.11) 6 (33.33) 61.5(56.8–65.0) 51.06(5.48) 120.44(22.47) 3.06(2.73–3.17) 0.10(0.05–2.09) 1.10(1.00-3.82) 297.50(226.80-498.33) 6.93(5.00-8.34) 82.85 (72.92-111.23) 7.72 (6.31–9.20) 1.06 (0.95–1.49) 0.82 (0.73–0.94) 2.28 (1.81–2.74) 3.55 (3.11–4.22) 22.24(3.13) 20.0(18.8–24.3) 98.5(82.8-112.8) 100.5(90.0-119.0) 68.3(17.67) 33 (75.0) 20 (45.5) 11(25.0) 5 (11.4) 13 (29.55) 7 (15.91) 53.0(48.9–60.0) 50.52(5.56) 125.07(19.65) 3.26(2.95–3.83) 3.94(0.28–19.68) 7.96(1.35–52.23) 1159.90(406.35-2479.45) 9.12(7.07–12.42) 117.55 (83.02-181.65) 14.35 (10.03–18.24) 1.08 (0.74–1.54) 0.99 (0.79–1.37) 2.36 (1.83–3.15) 3.69 (3.29–4.86) 0.522 0.126 0.261 0.064 0.053 1.000 0.848 1.000 0.137 0.193 0.171 0.003 0.732 0.452 0.024 0.002 0.002 < 0.001 0.008 0.016 < 0.001 0.710 0.051 0.368 0.381 Abbreviations: PIVSR, Postinfarction Ventricular Septal Rupture; LVEF, left ventricular ejection fraction; LVEDD, left ventricular end-diastolic dimension; HR, heart rate; SBP, systolic blood pressure; DBP, diastolic blood pressure; AMI, acute myocardial infarction; ECG, Electrocardiograph; CAD, coronary artery disease; LVEF, left ventricular ejection fraction; LVEDD, left ventricular end-diastolic dimension; NT-pro BNP, N-terminal prohormone of brain natriuretic peptide; CTn I, cardiac troponin I; ALT, alanine aminotransferase; AST, aspartate aminotransferase; LDH, lactate dehydrogenase; SUA, uric acid; WBC, white blood cell; TG, triglyceride; HDL, high density-lipoprotein; LDL, low-density lipoprotein; TC, total cholesterol. 2.Procedural characteristics of patients with PIVSR. Most of patients (n = 56, 90.3%) were medically managed which meant treated conservatively. Few of patients (n = 6, 9.7%) underwent surgical repair or device closure. Interestingly, all the patients who received surgical repair or interventional closure survived and got discharged. The patients in the survival group had a significantly longer duration from AMI to PIVSR compared with those in the non-survival group, P = 0.020; And the non-survival group had higher proportion of suffering from cardiogenic shock or heart failure (HF). There are 40.3% of patients (25/62) who underwent either percutaneous coronary intervention (PCI) or performing coronary artery bypass grafting (CABG) only. And 34 patients received coronary angiography (CAG). Among them, 64.7% of patients (22/34) were complicated with multi-vessel lesions. The survival group had a higher proportion of chronic types (72.2% vs 31.8%; p = 0.004). There are only 2 patients (11.1%) with intra-aortic balloon pump (IABP) implantation in the survival group, and 6 patients (13.6%) in the non-survival group doing. However, there was no significance between the two groups (11.1% vs 13.6%; p > 0.900). In this study, the size of the rupture and the ICU duration have no significance between the two groups. The details are shown in Table 2 . Table 2 Procedural characteristics of patients with PIVSR. Parameter Survival (n = 18) Non-Survival (n = 44) p-value The closure of VSR 6 0 <0.001 Surgical repair, n, % Device closure, n, % The duration from AMI to VSR, day Size of rupture, mm ICU duration, day Cardiogenic shock Heart failure Number of lesioned vessels Triple vessels, n, % Double vessels, n, % Single vessel, n, % Revascularization NO PCI or CABG IABP 4(22.2%) 2(11.1%) 7.00(1.8–14.8) 9.35 (5.85–12.70) 1.5 (0, 4.8) 1 (5.6%) 11 (61.1%) 12 4(33%) 2((17%) 6(50%) 7 (38.9%) 11 (61.1%) 2(11.1%) 0(0%) 0(0%) 1.0(1.0–5.0) 8.00(6.00-10.05) 2 (1.0-6.3) 21 (47.7%) 39 (88.6%) 22 11(50%) 5(23%) 6(27%) 30 (68.2%) 14(31.8%) 6(13.6%) 0.020 0.675 0.084 0.004 0.029 0.500 0.064 0.900 PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; IABP, intraaortic balloon pump. 3.Univariable and multivariable analysis predicating in-hospital death. Based on univariate analysis, nine variables (P < 0.1), including Cardiogenic shock, HF, PIVSR type, Revascularization, LVEF, log NT-pro BNP, Cardiac troponin I, WBC and Serum glucose, were related with the short-term mortality among these populations. Considering sample size and test efficiency, to confirm independent risk predictors of early mortality in patients with PIVSR and to avoid overadjustment and collinearity, HF, PIVSR type, Serum glucose, NT-pro BNP, Revascularization and Cardiac troponin I were adjusted by WBC count, Cardiogenic shock, and LVEF, based on the Akaike information criterion (AIC) under multivariate analysis ( Table 3 ) . Table 3 Univariable and Multivariable analysis predicating death in hospital. Predictor Univariable OR (95% CI) P-value Multivariable OR (95% CI) P-value LVEF Log NTpro BNP CTnI Serum glucose WBC VSR type* Revascularization Cardiogenic shock Heart failure 0.892(0.818–0.971) 2.259(0.924–5.523) 1.110(1.013–1.216) 1.235(1.007–1.515) 1.492(1.185–1.879) 0.179(0.053–0.602) 0.297(0.095–0.929) 15.522(1.898-126.954) 4.964(1.315–18.739) 0.009 0.074 0.025 0.043 0.001 0.005 0.037 0.011 0.018 0.803(0.689–0.936) 1.619(1.172–2.237) 47.706(2.859-795.945) 0.005 0.003 0.007 LVEF, left ventricular eject fraction; NT-pro BNP, N-terminal pro b-type natriuretic peptide; WBC, white blood cell; VSR, ventricular septal rupture; *VSR Type: Acute and Subacute (Within72 h Post AMI), Late presentation (More than 72 h Post AMI). 4.Development of a nomogram. We further prudently used the univariable and multivariable regression analysis results and chose one of the lowest AIC score models to develop the nomogram. The nomogram for PIVSR including LVEF, Cardiogenic Shock, WBC and Revascularization (Fig. 2 ) was used to identify patients whose prognosis were likely to be poor. The calibration curve showed a good fit during internal validation, while the HL test showed that our predicted and observed values were close (P = 0.939). Our model yielded an AUC value of 0.956 (95% CI 0.912–1.000) (Fig. 2 ). Meanwhile, The DCA of the nomogram was performed (Fig. 3 ). Our results showed that our model had a good net clinical benefit in this population. Discussion In this multicenter retrospective cohort study, we found that the mortality of PIVSR remained high, was 71.0% (44/62). Meanwhile, we identified that WBC, LVEF, cardiogenic shock were the independent predictors of short-term mortality. Finally, we developed the nomogram for predicting the risk of short-term mortality. Previous studies had indicated that leukocyte played an important role in systemic inflammatory reactions, and cardiogenic shock was commonly associated with a severe inflammatory response [ 22 – 24 ] . The high levels of total WBC count and C-reactive protein (CRP) may be considered as independent prognostic factors in patients with ACS [ 25 – 27 ] . Of note, a significant difference between two groups in LVEF was observed, suggesting an association between relatively low LVEF and increased mortality, even though LVEF in the non-survival group was still within the relatively normal range [ 28 , 29 ] . Due to its simplicity and ease of observation, LVEF was one of the indicators traditionally used for the early identification of high-risk patients with AMI [ 28 ] . Schlotter et al. had found that PIVSR complicating AMI frequently leads to cardiogenic shock [ 30 ] . Attia R et al. had reported that the 30-day mortality was 65% with strong correlation with cardiogenic shock [ 22 ] . Our study also confirmed higher mortality in patients who developed cardiogenic shock, emphasizing improving the hemodynamic status of patients during clinical intervention was crucial [ 31 ] and the need for early and effective hemodynamic management in this subset of patients. Furthermore, Phan DQ et al. had reported that revascularization strategies (with either PCI or CABG) were associated with benefit for ACS and all-cause mortality [ 32 ] . Several studies had indicated that coronary revascularization combined with the closure of rupture might be helpful in improving the prognosis of AMI patients [ 5 , 29 ] . Based on these, we chose the revascularization which was significant in univariate analysis as one variable of the nomogram for PIVSR. The size of the rupture and the ICU duration maybe not the predictors for the short-term mortality according to the group comparison analyses. Patients might be considered receiving procedural treatment to improve prognosis rather than consider the size of rupture much more [ 22 , 33 ] .Few of therapeutic regimens took into account the predicting model for this clinical complication. It was therefore necessary to inform the best-fitting combination of variables, associated with predicting the risk of short-term mortality, for developing an easy-to-use and reliable tool to inform clinical practice. In the present study, we established a nomogram consisting of four predictors including LVEF, cardiogenic shock, WBC count and whether underwent revascularization which can complement and update others already known, such as LVEF and WBC count before PIVSR occurring. Our prediction model was in good agreement with the actual results and performed well in discrimination after internal validation of the model by using multiple indicators during the validation process, including AUC, calibration curve, HL test, AIC and DCA, although we did not conduct an external validation due to the low incidence of PIVSR. Study limitations There were several limitations in the present study. Although all data were collected retrospectively, selection and recall bias could not be completely prevented, which could sway the final results. The study population was relatively small because of the low incidence of PIVSR in the current era, and the study period was long, which might have limited the number of risk factors associated with the mortality of PIVSR. This was a study from southeast China, therefore expanding the results to other regions might be imprudent. Conclusions This study described the current status of PIVSR and found the WBC count, cardiogenic shock, and LVEF as the independent predictive factors of short-term mortality. Moreover, the nomogram for PIVSR could provide physicians a new way to screen high-risk patients during early clinical practice, making this special patient population have net clinical benefit eventually. Abbreviations PIVSR AMI WBC LVEF ACS CHD VIF AUC HL test DCA HF PCI CABG CAG IABP NT-proBNP CTn I AIC CRP ECMO TCC post-infarction ventricular septal rupture acute myocardial infarction white blood cell count left ventricular ejection fraction Acute Coronary Syndromes congenital heart disease variable inflation factors the area under the receiver operating curve Hosmer Lemeshow goodness of fit test decision curve analysis heart failure percutaneous coronary intervention coronary artery bypass grafting coronary angiography intra-aortic balloon pump N-terminal prohormone of brain natriuretic peptide cardiac troponin I akaike information criterion C-reactive protein extracorporeal membrane oxygenation transcatheter closure Declarations Ethics approval and informed consent Medical Ethics Committee of the Second Affiliated Hospital of Army Medical University, the First Affiliated Hospital of Army Medical University and the First Affiliated Hospital of Chongqing Medical University approved all consenting procedures. Ethical review number was 2023-NO.031-01. The authors of this manuscript have certified that information contained herein was authentic and dependable. All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Given its retrospective nature, formal consent was not deemed necessary. Author contributions Wenjian Luo: Manuscript writing and data analysis; Li Wen: Manuscript writing; Jinning Zhang: Data analysis; Junyong Zhao: Data collection; Zelan Wang: Data collection; Xiaolin Luo: Data collection; Shixian Pi: Data collection; Yang Chen: Data collection; Jiawen Zhang: Data collection; Tao Li: Data collection; Zhihui Zhang: Data collection; Shiyong Yu: Study design and manuscript review; Zhexue Qin: Study design and manuscript review; Dan Luo: Study design. Acknowledgements Not applicable. Funding Funding information is not available. Data availability No datasets were generated or analyzed during the current study. Conflicts of interest The authors declare that they have no conflicts of interest. References Jones BM, Kapadia SR, Smedira NG, Robich M, Tuzcu EM, Menon V et al. Ventricular septal rupture complicating acute myocardial infarction: a contemporary review. Eur Heart J, 35(31). 2014; 2060-68. David TE. Post-infarction ventricular septal rupture. Annals Cardiothorac Surg, 11(3). 2022; 261 – 67. Okamoto Y, Yamamoto K, Yoshii S. Triple patch technique to repair ventricular septal rupture. Ann Cardiothorac Surg, 11(3). 2022; 273 – 80. Bhardwaj A, Kumar S, Salas De Armas IA, Nascimbene A, Nathan S, Kar B, et al. Pre- and post-operative mechanical circulatory support in surgical repair of post-acute myocardial infarction mechanical complications. Ann Cardiothorac Surg. 2022;11(3):304–09. Gong FF, Vaitenas I, Malaisrie SC, Maganti K. Mechanical Complications of Acute Myocardial Infarction: A Review. JAMA Cardiol, 6(3). 2021; 341 – 49. Ronco D, Matteucci M, Kowalewski M, De Bonis M, Formica F, Jiritano F et al. Surgical Treatment of Postinfarction Ventricular Septal Rupture. JAMA Netw Open, 4(10). 2021; e2128309. Chen T, Liu Y, Zhang J, Sun Z, Cheng J, Han Y et al. Comparison between Cardiac CTA and Echocardiography for Assessment of Ventricular Septal Rupture Diameter and Its Effect on Transcatheter Closure. Cardiovasc Ther, 20222022; 5011286. Ronco D, Matteucci M, Ravaux JM, Marra S, Torchio F, Corazzari C, et al. Mechanical Circulatory Support as a Bridge to Definitive Treatment in Post-Infarction Ventricular Septal Rupture. JACC Cardiovasc Interv. 2021;14(10):1053–66. Elbadawi A, Elgendy IY, Mahmoud K, Barakat AF, Mentias A, Mohamed AH, et al. Temporal Trends and Outcomes of Mechanical Complications in Patients With Acute Myocardial Infarction. JACC Cardiovasc Interv. 2019;12(18):1825–36. Arnaoutakis GJ, Zhao Y, George TJ, Sciortino CM, Mccarthy PM, Conte JV. Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg, 94(2). 2012; 436 – 43; discussion 43 – 4. Zhang XY, Bian LZ, Tian NL. The Clinical Outcomes of Ventricular Septal Rupture Secondary to Acute Myocardial Infarction: A Retrospective, Observational Trial. J Interv Cardiol, 20212021; 3900269. Cho JH, Sattiraju S, Mehta S, Missov E. Delayed ventricular septal rupture complicating acute inferior wall myocardial. BMC Res Notes, 2013; 124. Bakhshi H, Gattani R, Ekanem E, Singh R, Desai M, Speir AM et al. Ventricular septal rupture and cardiogenic shock complicating STEMI during COVID-19 pandemic: An old foe re-emerges. Heart Lung, 50(2). 2021; 292 – 95. Arai R, Fukamachi D, Akutsu N, Okumura Y, Tanaka M. Ventricular Septal Rupture After Recent Myocardial Infarction in the Very Elderly. Int Heart J, 61(4). 2020; 831 – 37. Ma D, Zhang Z, Zhang S, Wang Z, Zhang G, Wang C et al. Treatment Strategies for Ventricular Septal Rupture After Myocardial Infarction: A Single-Center Experience. Front Cardiovasc Med, 92022; 843625. Yang C, Sun Y, Zou D, Sun Z, Zhang X, Su G, et al. Transcatheter closure of ventricular septal rupture with prolonged support of intra-aortic balloon pump after primary PCI: a case report. BMC Cardiovasc Disord. 2021;21(1):605. Crenshaw BS, Granger CB, Birnbaum Y, Pieper KS, Morris DC, Vahanian A et al. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators. Circulation, 1012000; 27–32. Wang L, Xiao LL, Liu C, Zhang YZ, Zhao XY, Li L et al. Clinical Characteristics and Contemporary Prognosis of Ventricular Septal Rupture Complicating Acute Myocardial Infarction: A Single-Center Experience. Front Cardiovasc Med, 82021; 679148. American Diabetes A. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S13–28. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J, 39(33). 2018; 3021 – 104. Vickers AJ, Cronin AM, Elkin EB, Gonen M. Extensions to decision curve analysis, a novel method for evaluating diagnostic tests, prediction models and molecular markers. BMC Med Inf Decis Mak, 2008; 53. Attia R, Blauth C. Which patients might be suitable for a septal occluder device closure of postinfarction ventricular septal rupture rather than immediate surgery? Interact Cardiovasc Thorac Surg. 2010;11(5):626–9. Thiele H, Kaulfersch C, Daehnert I, Schoenauer M, Eitel I, Borger M et al. Immediate primary transcatheter closure of postinfarction ventricular septal defects. Eur Heart J, 30(1). 2009; 81 – 8. Bradley SM, Borgerding JA, Wood GB, Maynard C, Fihn SD, Incidence. Risk Factors, and Outcomes Associated With In-Hospital Acute Myocardial Infarction. JAMA Netw Open, 2(1). 2019; e187348. Guasti L, Dentali F, Castiglioni L, Maroni L, Marino F, Squizzato A et al. Neutrophils and clinical outcomes in patients with acute coronary syndromes and/or cardiac revascularisation. Thromb Haemost, 106(10). 2017; 591 – 99. Wheeler J. Associations between differential leucocyte count and incident coronary heart disease: 1764 incident cases from seven prospective studies of 30 374 individuals. Eur Heart J. 2004;25(15):1287–92. Kaminska J, Koper OM, Siedlecka-Czykier E, Matowicka-Karna J, Bychowski J, Kemona H. The utility of inflammation and platelet biomarkers in patients with acute coronary syndromes. Saudi J Biol Sci. 2018;25(7):1263–71. Bristow MR, Kao DP, Breathett KK, Altman NL, Gorcsan J 3rd, Gill EA et al. Structural and Functional Phenotyping of the Failing Heart: Is the Left Ventricular Ejection Fraction Obsolete? JACC Heart Fail, 5(11). 2017; 772 – 81. Huang SM, Huang SC, Wang CH, Wu IH, Chi NH, Yu HY et al. Risk factors and outcome analysis after surgical management of ventricular septal rupture complicating acute myocardial infarction: a retrospective analysis. J Cardiothorac Surg, 102015; 66. Schlotter F, De Waha S, Eitel I, Desch S, Fuernau G, Thiele H. Interventional post-myocardial infarction ventricular septal defect closure: a systematic review of current evidence. EuroIntervention. 2016;12(1):94–102. Hua K, Peng Z, Yang X. Long-Term Survival and Risk Factors for Post-Infarction Ventricular Septal Rupture. Heart Lung Circ, 30(7). 2021; 978 – 85. Phan DQ, Rostomian AH, Schweis F, Chung J, Lin B, Zadegan R, et al. Revascularization Versus Medical Therapy in Patients Aged 80 Years and Older with Acute Myocardial Infarction. J Am Geriatr Soc. 2020;68(11):2525–33. Egbe AC, Poterucha JT, Rihal CS, Taggart NW, Cetta F, Cabalka AK, et al. Transcatheter closure of postmyocardial infarction, iatrogenic, and postoperative ventricular septal defects: The Mayo Clinic experience. Catheter Cardiovasc Interv. 2015;86(7):1264–70. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 Oct, 2024 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted Editorial decision: Revision requested 30 Jul, 2024 Reviews received at journal 16 Jul, 2024 Reviews received at journal 10 Jul, 2024 Reviewers agreed at journal 02 Jul, 2024 Reviewers agreed at journal 02 Jul, 2024 Reviewers invited by journal 02 Jul, 2024 Editor assigned by journal 27 Jun, 2024 Submission checks completed at journal 27 Jun, 2024 First submitted to journal 23 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4625058","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":327922148,"identity":"efdac22a-4371-4270-9589-dbe0cb5dc953","order_by":0,"name":"Wenjian Luo","email":"","orcid":"","institution":"Army Medical University, Third Military Medical University)","correspondingAuthor":false,"prefix":"","firstName":"Wenjian","middleName":"","lastName":"Luo","suffix":""},{"id":327922149,"identity":"a04489a6-7c6c-4665-b8f6-919a298f7266","order_by":1,"name":"Li Wen","email":"","orcid":"","institution":"the First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Wen","suffix":""},{"id":327922150,"identity":"6690a4f4-5f89-45da-894b-ccee90752476","order_by":2,"name":"Jinning Zhang","email":"","orcid":"","institution":"Army Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jinning","middleName":"","lastName":"Zhang","suffix":""},{"id":327922151,"identity":"2199c937-f675-4cf7-bb71-89a8f0752e4f","order_by":3,"name":"Junyong Zhao","email":"","orcid":"","institution":"Army Medical University, Third Military Medical University)","correspondingAuthor":false,"prefix":"","firstName":"Junyong","middleName":"","lastName":"Zhao","suffix":""},{"id":327922152,"identity":"cf2c9db3-a461-4e04-abcd-27fbe0d9555a","order_by":4,"name":"Zelan Wang","email":"","orcid":"","institution":"Army Medical University, Third Military Medical University)","correspondingAuthor":false,"prefix":"","firstName":"Zelan","middleName":"","lastName":"Wang","suffix":""},{"id":327922153,"identity":"9f70e6b1-7642-444f-828f-f72bceb0ebad","order_by":5,"name":"Xiaolin Luo","email":"","orcid":"","institution":"Army Medical University, Third Military Medical University)","correspondingAuthor":false,"prefix":"","firstName":"Xiaolin","middleName":"","lastName":"Luo","suffix":""},{"id":327922154,"identity":"0162844d-30e5-42a5-9b62-97fb0765a969","order_by":6,"name":"Shixian Pi","email":"","orcid":"","institution":"Army Medical University, Third Military Medical University)","correspondingAuthor":false,"prefix":"","firstName":"Shixian","middleName":"","lastName":"Pi","suffix":""},{"id":327922155,"identity":"c33ef5e9-4430-44ff-a86d-12f8ed8943d9","order_by":7,"name":"Yang Chen","email":"","orcid":"","institution":"Army Medical University, Third Military Medical University)","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Chen","suffix":""},{"id":327922158,"identity":"ddf88d50-fcac-4c78-a4ba-27675afdb772","order_by":8,"name":"Jiawen Zhang","email":"","orcid":"","institution":"Army Medical University, Third Military Medical University)","correspondingAuthor":false,"prefix":"","firstName":"Jiawen","middleName":"","lastName":"Zhang","suffix":""},{"id":327922159,"identity":"6733b86f-ddfb-4d20-a692-41878b8d9072","order_by":9,"name":"Tao Li","email":"","orcid":"","institution":"Army Medical University, Third Military Medical University)","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Li","suffix":""},{"id":327922160,"identity":"87c9b5b4-f7a5-41ab-a4c6-3dea46695f97","order_by":10,"name":"Zhihui Zhang","email":"","orcid":"","institution":"Army Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhihui","middleName":"","lastName":"Zhang","suffix":""},{"id":327922161,"identity":"7dc8112a-a6ed-4fef-9baf-f9c92fbd0171","order_by":11,"name":"Shiyong Yu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYDCCAzCGBGMDiJJjY28/gEMtXAtEKUyLMR/PmQRitUD4ifMkHAzw6uA73vz8wcc9hxPnz25uk/i4oza9TYIhgeFHxTacWiTPHDNsnPHscOKGOwfbJGeeOZ7bJt14gLHnzG2cWgxu5DA28xwAapFIbJPmbTuW2yZzIIGZsY0ILfNnQLSks0kkGBCnpeEGWEtNAkEtIL/MnHEg3XjDjcRmy5ltBwzbgIF8EJ9fgCH24MOHA9ay82ekP7zxsa1OXr69/eCDHxW4tUBBM4hgAUbNYTD3ACH1QFAHIpg/QBmjYBSMglEwClAAABRCZX+pkW7RAAAAAElFTkSuQmCC","orcid":"","institution":"Army Medical University, Third Military Medical University)","correspondingAuthor":true,"prefix":"","firstName":"Shiyong","middleName":"","lastName":"Yu","suffix":""},{"id":327922162,"identity":"1d858d87-e92d-4e11-9b8c-252197d776ac","order_by":12,"name":"Zhexue Qin","email":"","orcid":"","institution":"Army Medical University, Third Military Medical University)","correspondingAuthor":false,"prefix":"","firstName":"Zhexue","middleName":"","lastName":"Qin","suffix":""},{"id":327922164,"identity":"494c9d07-cac4-4778-8d3f-82681a6dce8e","order_by":13,"name":"Dan Luo","email":"","orcid":"","institution":"Army Medical University","correspondingAuthor":false,"prefix":"","firstName":"Dan","middleName":"","lastName":"Luo","suffix":""}],"badges":[],"createdAt":"2024-06-23 11:38:56","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4625058/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4625058/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13019-024-03077-z","type":"published","date":"2024-10-01T15:57:38+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60713793,"identity":"a211558a-e751-4a57-ba06-757d1829573a","added_by":"auto","created_at":"2024-07-19 20:45:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":238099,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart for enrolling patients with PIVSR.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Onlinefigure001.png","url":"https://assets-eu.researchsquare.com/files/rs-4625058/v1/9baf3015a0ab5262ecf8730b.png"},{"id":60713667,"identity":"5e36327a-c3e4-4625-8ef1-53c41445d59f","added_by":"auto","created_at":"2024-07-19 20:37:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":16776,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eNomogram to predict the risk of short-term mortality in patients with PIVSR\u003c/strong\u003e.\u003c/p\u003e","description":"","filename":"Onlinefigure02.png","url":"https://assets-eu.researchsquare.com/files/rs-4625058/v1/8d1136d05c9edf7564133a8e.png"},{"id":60713669,"identity":"d722268f-e3bc-4bc4-b329-5fc30e1f0003","added_by":"auto","created_at":"2024-07-19 20:37:41","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":23593,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDCA for our model.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn DCA, the red curve in the figure represents that all the patients would dead in short term, the straight green line represents that patients would not dead in short term and the blue curve represents the clinical benefit of our model.\u003c/p\u003e","description":"","filename":"Onlinefigure03.png","url":"https://assets-eu.researchsquare.com/files/rs-4625058/v1/948dfe7b7ce58309144b8206.png"},{"id":66096828,"identity":"939a6c22-ff17-4a46-ac7b-69f945787bb4","added_by":"auto","created_at":"2024-10-07 16:10:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1085323,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4625058/v1/56305952-a30e-4c21-a16c-9bb1811db80e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Short-term Outcomes and Risk Factors of Post-myocardial Infarction Ventricular Septal Rupture: a Multi-center Retrospective Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePost-infarction ventricular septal rupture (PIVSR) is one of the most severe types of mechanical complications after acute myocardial infarction (AMI), which has high mortality and poor prognosis\u003csup\u003e[\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. And if left untreated, it is almost inevitably fatal\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Currently, improvements in revascularization, including pharmacological, catheter-based and surgical, have resulted in improved outcomes for patients with AMI\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, but in-hospital mortality of this mechanical complication after AMI remained still as high as 60% and the prognosis has not improved over the past 2 decades\u003csup\u003e[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, derived from the unavoidable remodeling based on a large amount of infarcted myocardium. Early diagnosis and risk stratification are crucial to improving outcomes\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. However, studies on this disease in recent years are still limited, mainly because of the rarity for this disease\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Moreover, most of the previous studies came from single-center studies or case reports\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e, which would limit further explorations for better clinical management of PIVSR. Crenshaw BS et al. had identified risk factors associated with increased mortality in patients who developed PIVSR\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Thus, identifying robust predictors of the early mortality might help clinical decision and improve the prognosis of this population, which would be a meaningful way to improve the current complex situation. Based on these, we conducted this present real-world multi-center observational study to evaluate the mortality of PIVSR and try to identify the risk predictors for early mortality, and then provide some information regarding the management of such patients\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis was a multi-center, retrospective registry designed to reflect the \u0026ldquo;real world\u0026rdquo; clinical practice since 2013. The primary data were extracted from the electronic medical or archived records by trained staff. Standardized definitions for all patient-related variables and clinical diagnoses were used. Participant data had been anonymized and had not distorted the scholarly meaning.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData source and population\u003c/h2\u003e \u003cp\u003eFrom June 2013 to December 2022, we retrospectively studied patients hospitalized for PIVSR at the Second Affiliated Hospital of Army Medical University, the First Affiliated Hospital of Army Medical University and the First Affiliated Hospital of Chongqing Medical University, Chongqing, China. The inclusion criteria for this study were as follows: (1) Age\u0026thinsp;\u0026gt;\u0026thinsp;18 at inclusion; (2) With the evidence of left-to-right shunt in ventricular septal based on the ultrasonic cardiogram; (3) Definitely diagnosed as AMI, including ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI). The diagnosis of AMI was based on typical clinical symptoms, electrocardiographic findings of ST elevation 0.1mV in more than two limb leads or \u0026gt;\u0026thinsp;0.2mV in two or more contiguous precordial leads, as well as cardiac enzyme elevation. The exclusion criteria for this study were as follows: (1) Ventricular septal defect caused by congenital heart disease or traumatic heart injury rather than caused by AMI; (2) Patients with malignant tumors or end-stage diseases; (3) No confirmation of the ultrasonic cardiogram; (4) Patients with the ambiguous time for AMI. Finally, 62 patients were included in the study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). During the retrospective screening of the medical records, the baseline and procedural characteristics of enrolled patients were collected for further analyses, as well as the relevant laboratory data. Acute \u0026amp; Sub-acute type was defined as being present PIVSR within 72 hours, and late type was defined as being present PIVSR more than 72 hours. The diagnosis of diabetes mellitus are based on the standards of medical care in diabetes mellitus(2019) issued by The American Diabetes Association (ADA)\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. The 2018 ESH/ESC guidelines for the management of arterial hypertension are referred to the diagnosis of hypertension\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. All enrolled patients were divided into the survival group or the non-survival group based on whether death occurred within 30 days after diagnosis of PIVSR.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eBaseline characteristics and clinical outcomes were expressed as number, percentage, or mean and standard deviation (SD) as appropriate. Numerical variables would be shown as median and interquartile range (IQR) values if the data were not normal distribution. categorical variables in the survival group and the non-survival group were compared using Fisher\u0026rsquo;s exact or chi-square test. Student\u0026rsquo;s test or Wilcoxon rank-sum test was performed for analyzing continuous data as appropriate. P values were 2-tailed, and P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was statistically significant unless otherwise indicated.\u003c/p\u003e \u003cp\u003eWe used the multiple imputation method in the MICE R package to fill in missing data. Then the univariable logistic regression was used for screening predictors of mortality. The multivariate logistic regression model was established using these variables. The values are related to a significant difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.10) in the univariable logistic regression model and a significant difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the multivariable regression model. And multicollinearity was evaluated by variable inflation factors (VIF). The AUC, sensitivity and specificity were used to evaluate the model\u0026rsquo;s performance. Finally, the nomogram was plotted using the R package \u0026ldquo;rms\u0026rdquo;. The calibration C index (bootstrap resampling 1,000 times), the calibration curve (relationship between observation probability and prediction probability), Hosmer Lemeshow goodness of fit test (HL test), and brier score were used to evaluate the degree of consistency between observed and predicted outcomes. Decision curve analysis (DCA) was used to assess the net clinical benefit\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. All analyses were performed using R language (version 4.2.1).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003e1.Baseline Comparison between the Two Groups.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOnly 18 patients survived in the first month and got discharged successfully, showing high mortality of PIVSR (71.0%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Of all the patients, mean age was 70.7\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7 years (38.7% female), 25.8% of patients (16/62) had hyperlipidemia, 43.5% of patients (27/62) had hypertension, 30.6% of patients (19/62) had diabetes mellitus, and the patients who had the history of ACS accounted for 16.1%. Most (n\u0026thinsp;=\u0026thinsp;47 [75.8%]) of the patients were in Killip class III or IV at the time of rupture diagnosis. All the patients enrolled were diagnosed as STEMI. The baseline between the two groups were generally consistent and showed no statistical significance. Patients in the survival group were more likely to be a higher level of LVEF, but more likely to have a lower level of Serum glucose, Cardiac troponin I and WBC count. More details about the patients with PIVSR are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of patients with PIVSR.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eNon-Survival\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, year\u003c/p\u003e \u003cp\u003eMale, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e70.7(10.70)\u003c/p\u003e \u003cp\u003e38 (61.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e68.4(7.35)\u003c/p\u003e \u003cp\u003e11 (61.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e71.61(11.75)\u003c/p\u003e \u003cp\u003e27 (61.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.199\u003c/p\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eRespiratory Rate\u003c/p\u003e \u003cp\u003eHR\u003c/p\u003e \u003cp\u003eSBP, mmHg\u003c/p\u003e \u003cp\u003eDBP, mmHg\u003c/p\u003e \u003cp\u003eKillip Ⅲ/Ⅳ class, %\u003c/p\u003e \u003cp\u003eHypertension, %\u003c/p\u003e \u003cp\u003eHyperlipidemia, %\u003c/p\u003e \u003cp\u003eHistory of CAD, %\u003c/p\u003e \u003cp\u003eCurrent smoker, %\u003c/p\u003e \u003cp\u003eCurrent drinker, %\u003c/p\u003e \u003cp\u003eLVEF, %\u003c/p\u003e \u003cp\u003eLVEDD, mm\u003c/p\u003e \u003cp\u003eHemoglobin, g/L\u003c/p\u003e \u003cp\u003eLog NT-pro BNP\u003c/p\u003e \u003cp\u003eCTn I, mmol/L\u003c/p\u003e \u003cp\u003eCK-MB, IU/L\u003c/p\u003e \u003cp\u003eLDH, IU /L\u003c/p\u003e \u003cp\u003eSerum glucose, mmol/L\u003c/p\u003e \u003cp\u003eCreatinine umol/L\u003c/p\u003e \u003cp\u003eWBC, 10\u003csup\u003e6\u003c/sup\u003e/L\u003c/p\u003e \u003cp\u003eTG, mmol/L\u003c/p\u003e \u003cp\u003eHDL, mmol/L\u003c/p\u003e \u003cp\u003eLDL, mmol/L\u003c/p\u003e \u003cp\u003eTC, mmol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e22.42(3.24)\u003c/p\u003e \u003cp\u003e20.0(18.3\u0026ndash;22.8)\u003c/p\u003e \u003cp\u003e95.5(82.3-109.5)\u003c/p\u003e \u003cp\u003e101.5(92.0-124.8)\u003c/p\u003e \u003cp\u003e70.3(16.10)\u003c/p\u003e \u003cp\u003e47 (75.8)\u003c/p\u003e \u003cp\u003e27 (43.5)\u003c/p\u003e \u003cp\u003e16(25.8)\u003c/p\u003e \u003cp\u003e10 (16.1)\u003c/p\u003e \u003cp\u003e15 (24.19)\u003c/p\u003e \u003cp\u003e13 (20.97)\u003c/p\u003e \u003cp\u003e56.0(50.0\u0026ndash;61.0)\u003c/p\u003e \u003cp\u003e50.68(5.50)\u003c/p\u003e \u003cp\u003e123.72(20.43)\u003c/p\u003e \u003cp\u003e3.16(2.84\u0026ndash;3.63)\u003c/p\u003e \u003cp\u003e1.74(0.05\u0026ndash;15.18)\u003c/p\u003e \u003cp\u003e3.82(1.08\u0026ndash;41.93)\u003c/p\u003e \u003cp\u003e742.20(321.5-2001.5)8.04(6.30-10.51)\u003c/p\u003e \u003cp\u003e107.5(79.15-148.72)\u003c/p\u003e \u003cp\u003e11.43 (7.95\u0026ndash;16.36)\u003c/p\u003e \u003cp\u003e1.08 (0.86\u0026ndash;1.55)\u003c/p\u003e \u003cp\u003e0.94 (0.74\u0026ndash;1.26)\u003c/p\u003e \u003cp\u003e2.34 (1.81\u0026ndash;3.13)\u003c/p\u003e \u003cp\u003e3.65 (3.29\u0026ndash;4.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e22.86(3.55)\u003c/p\u003e \u003cp\u003e20.0(18.3\u0026ndash;20.0)\u003c/p\u003e \u003cp\u003e90.0(82.0-101.5)\u003c/p\u003e \u003cp\u003e121.5(98.0-126.5)\u003c/p\u003e \u003cp\u003e75.3(10.11)\u003c/p\u003e \u003cp\u003e14 (77.8)\u003c/p\u003e \u003cp\u003e7 (39.0)\u003c/p\u003e \u003cp\u003e5(27.8)\u003c/p\u003e \u003cp\u003e5 (27.8)\u003c/p\u003e \u003cp\u003e2 (11.11)\u003c/p\u003e \u003cp\u003e6 (33.33)\u003c/p\u003e \u003cp\u003e61.5(56.8\u0026ndash;65.0)\u003c/p\u003e \u003cp\u003e51.06(5.48)\u003c/p\u003e \u003cp\u003e120.44(22.47)\u003c/p\u003e \u003cp\u003e3.06(2.73\u0026ndash;3.17)\u003c/p\u003e \u003cp\u003e0.10(0.05\u0026ndash;2.09)\u003c/p\u003e \u003cp\u003e1.10(1.00-3.82)\u003c/p\u003e \u003cp\u003e297.50(226.80-498.33)\u003c/p\u003e \u003cp\u003e6.93(5.00-8.34)\u003c/p\u003e \u003cp\u003e82.85 (72.92-111.23)\u003c/p\u003e \u003cp\u003e7.72 (6.31\u0026ndash;9.20)\u003c/p\u003e \u003cp\u003e1.06 (0.95\u0026ndash;1.49)\u003c/p\u003e \u003cp\u003e0.82 (0.73\u0026ndash;0.94)\u003c/p\u003e \u003cp\u003e2.28 (1.81\u0026ndash;2.74)\u003c/p\u003e \u003cp\u003e3.55 (3.11\u0026ndash;4.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e22.24(3.13)\u003c/p\u003e \u003cp\u003e20.0(18.8\u0026ndash;24.3)\u003c/p\u003e \u003cp\u003e98.5(82.8-112.8) 100.5(90.0-119.0) 68.3(17.67)\u003c/p\u003e \u003cp\u003e33 (75.0)\u003c/p\u003e \u003cp\u003e20 (45.5)\u003c/p\u003e \u003cp\u003e11(25.0)\u003c/p\u003e \u003cp\u003e5 (11.4)\u003c/p\u003e \u003cp\u003e13 (29.55)\u003c/p\u003e \u003cp\u003e7 (15.91)\u003c/p\u003e \u003cp\u003e53.0(48.9\u0026ndash;60.0)\u003c/p\u003e \u003cp\u003e50.52(5.56)\u003c/p\u003e \u003cp\u003e125.07(19.65)\u003c/p\u003e \u003cp\u003e3.26(2.95\u0026ndash;3.83)\u003c/p\u003e \u003cp\u003e3.94(0.28\u0026ndash;19.68)\u003c/p\u003e \u003cp\u003e7.96(1.35\u0026ndash;52.23)\u003c/p\u003e \u003cp\u003e1159.90(406.35-2479.45)\u003c/p\u003e \u003cp\u003e9.12(7.07\u0026ndash;12.42)\u003c/p\u003e \u003cp\u003e117.55 (83.02-181.65)\u003c/p\u003e \u003cp\u003e14.35 (10.03\u0026ndash;18.24)\u003c/p\u003e \u003cp\u003e1.08 (0.74\u0026ndash;1.54)\u003c/p\u003e \u003cp\u003e0.99 (0.79\u0026ndash;1.37)\u003c/p\u003e \u003cp\u003e2.36 (1.83\u0026ndash;3.15)\u003c/p\u003e \u003cp\u003e3.69 (3.29\u0026ndash;4.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003cp\u003e0.126\u003c/p\u003e \u003cp\u003e0.261\u003c/p\u003e \u003cp\u003e0.064\u003c/p\u003e \u003cp\u003e0.053\u003c/p\u003e \u003cp\u003e1.000\u003c/p\u003e \u003cp\u003e0.848\u003c/p\u003e \u003cp\u003e1.000\u003c/p\u003e \u003cp\u003e0.137\u003c/p\u003e \u003cp\u003e0.193\u003c/p\u003e \u003cp\u003e0.171\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.732\u003c/p\u003e \u003cp\u003e0.452\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.024\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.016\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.710\u003c/p\u003e \u003cp\u003e0.051\u003c/p\u003e \u003cp\u003e0.368\u003c/p\u003e \u003cp\u003e0.381\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eAbbreviations: PIVSR, Postinfarction Ventricular Septal Rupture; LVEF, left ventricular ejection fraction; LVEDD, left ventricular end-diastolic dimension; HR, heart rate; SBP, systolic blood pressure; DBP, diastolic blood pressure; AMI, acute myocardial infarction; ECG, Electrocardiograph; CAD, coronary artery disease; LVEF, left ventricular ejection fraction; LVEDD, left ventricular end-diastolic dimension; NT-pro BNP, N-terminal prohormone of brain natriuretic peptide; CTn I, cardiac troponin I; ALT, alanine aminotransferase; AST, aspartate aminotransferase; LDH, lactate dehydrogenase; SUA, uric acid; WBC, white blood cell; TG, triglyceride; HDL, high density-lipoprotein; LDL, low-density lipoprotein; TC, total cholesterol.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e2.Procedural characteristics of patients with PIVSR.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eMost of patients (n\u0026thinsp;=\u0026thinsp;56, 90.3%) were medically managed which meant treated conservatively. Few of patients (n\u0026thinsp;=\u0026thinsp;6, 9.7%) underwent surgical repair or device closure. Interestingly, all the patients who received surgical repair or interventional closure survived and got discharged. The patients in the survival group had a significantly longer duration from AMI to PIVSR compared with those in the non-survival group, P\u0026thinsp;=\u0026thinsp;0.020; And the non-survival group had higher proportion of suffering from cardiogenic shock or heart failure (HF). There are 40.3% of patients (25/62) who underwent either percutaneous coronary intervention (PCI) or performing coronary artery bypass grafting (CABG) only. And 34 patients received coronary angiography (CAG). Among them, 64.7% of patients (22/34) were complicated with multi-vessel lesions. The survival group had a higher proportion of chronic types (72.2% vs 31.8%; p\u0026thinsp;=\u0026thinsp;0.004). There are only 2 patients (11.1%) with intra-aortic balloon pump (IABP) implantation in the survival group, and 6 patients (13.6%) in the non-survival group doing. However, there was no significance between the two groups (11.1% vs 13.6%; p\u0026thinsp;\u0026gt;\u0026thinsp;0.900). In this study, the size of the rupture and the ICU duration have no significance between the two groups. The details are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eProcedural characteristics of patients with PIVSR.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-Survival (n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe closure of VSR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical repair, n, %\u003c/p\u003e \u003cp\u003eDevice closure, n, %\u003c/p\u003e \u003cp\u003eThe duration from\u003c/p\u003e \u003cp\u003eAMI to VSR, day\u003c/p\u003e \u003cp\u003eSize of rupture, mm\u003c/p\u003e \u003cp\u003eICU duration, day\u003c/p\u003e \u003cp\u003eCardiogenic shock\u003c/p\u003e \u003cp\u003eHeart failure\u003c/p\u003e \u003cp\u003eNumber of lesioned vessels\u003c/p\u003e\u003cp\u003eTriple vessels, n, %\u003c/p\u003e\u003cp\u003eDouble vessels, n, %\u003c/p\u003e\u003cp\u003eSingle vessel, n, %\u003c/p\u003e\u003cp\u003eRevascularization\u003c/p\u003e\u003cp\u003eNO\u003c/p\u003e\u003cp\u003ePCI or CABG\u003c/p\u003e\u003cp\u003eIABP\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(22.2%)\u003c/p\u003e \u003cp\u003e2(11.1%)\u003c/p\u003e \u003cp\u003e7.00(1.8\u0026ndash;14.8)\u003c/p\u003e \u003cp\u003e9.35 (5.85\u0026ndash;12.70) 1.5 (0, 4.8)\u003c/p\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003cp\u003e11 (61.1%)\u003c/p\u003e \u003cp\u003e12\u003c/p\u003e \u003cp\u003e4(33%)\u003c/p\u003e \u003cp\u003e2((17%)\u003c/p\u003e \u003cp\u003e6(50%)\u003c/p\u003e \u003cp\u003e7 (38.9%)\u003c/p\u003e \u003cp\u003e11 (61.1%)\u003c/p\u003e \u003cp\u003e2(11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003cp\u003e1.0(1.0\u0026ndash;5.0)\u003c/p\u003e \u003cp\u003e8.00(6.00-10.05)\u003c/p\u003e \u003cp\u003e2 (1.0-6.3)\u003c/p\u003e \u003cp\u003e21 (47.7%)\u003c/p\u003e \u003cp\u003e39 (88.6%)\u003c/p\u003e \u003cp\u003e22\u003c/p\u003e \u003cp\u003e11(50%)\u003c/p\u003e \u003cp\u003e5(23%)\u003c/p\u003e \u003cp\u003e6(27%)\u003c/p\u003e \u003cp\u003e30 (68.2%)\u003c/p\u003e \u003cp\u003e14(31.8%)\u003c/p\u003e \u003cp\u003e6(13.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.020\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.675\u003c/p\u003e \u003cp\u003e0.084\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.029\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.500\u003c/p\u003e \u003cp\u003e0.064\u003c/p\u003e \u003cp\u003e0.900\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003ePCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; IABP, intraaortic balloon pump.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.Univariable and multivariable analysis predicating in-hospital death.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eBased on univariate analysis, nine variables (P\u0026thinsp;\u0026lt;\u0026thinsp;0.1), including Cardiogenic shock, HF, PIVSR type, Revascularization, LVEF, log NT-pro BNP, Cardiac troponin I, WBC and Serum glucose, were related with the short-term mortality among these populations. Considering sample size and test efficiency, to confirm independent risk predictors of early mortality in patients with PIVSR and to avoid overadjustment and collinearity, HF, PIVSR type, Serum glucose, NT-pro BNP, Revascularization and Cardiac troponin I were adjusted by WBC count, Cardiogenic shock, and LVEF, based on the Akaike information criterion (AIC) under multivariate analysis \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariable and Multivariable analysis predicating death in hospital.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePredictor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnivariable\u003c/p\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMultivariable\u003c/p\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF\u003c/p\u003e \u003cp\u003eLog NTpro BNP\u003c/p\u003e \u003cp\u003eCTnI\u003c/p\u003e \u003cp\u003eSerum glucose\u003c/p\u003e \u003cp\u003eWBC\u003c/p\u003e \u003cp\u003eVSR type*\u003c/p\u003e \u003cp\u003eRevascularization\u003c/p\u003e \u003cp\u003eCardiogenic shock\u003c/p\u003e \u003cp\u003eHeart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.892(0.818\u0026ndash;0.971)\u003c/p\u003e \u003cp\u003e2.259(0.924\u0026ndash;5.523)\u003c/p\u003e \u003cp\u003e1.110(1.013\u0026ndash;1.216)\u003c/p\u003e \u003cp\u003e1.235(1.007\u0026ndash;1.515)\u003c/p\u003e \u003cp\u003e1.492(1.185\u0026ndash;1.879)\u003c/p\u003e \u003cp\u003e0.179(0.053\u0026ndash;0.602)\u003c/p\u003e \u003cp\u003e0.297(0.095\u0026ndash;0.929)\u003c/p\u003e \u003cp\u003e15.522(1.898-126.954)\u003c/p\u003e \u003cp\u003e4.964(1.315\u0026ndash;18.739)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003cp\u003e0.074\u003c/p\u003e \u003cp\u003e0.025\u003c/p\u003e \u003cp\u003e0.043\u003c/p\u003e \u003cp\u003e0.001\u003c/p\u003e \u003cp\u003e0.005\u003c/p\u003e \u003cp\u003e0.037\u003c/p\u003e \u003cp\u003e0.011\u003c/p\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.803(0.689\u0026ndash;0.936)\u003c/p\u003e \u003cp\u003e1.619(1.172\u0026ndash;2.237)\u003c/p\u003e \u003cp\u003e47.706(2.859-795.945)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003cp\u003e0.003\u003c/p\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eLVEF, left ventricular eject fraction; NT-pro BNP, N-terminal pro b-type natriuretic peptide; WBC, white blood cell; VSR, ventricular septal rupture; *VSR Type: Acute and Subacute (Within72 h Post AMI), Late presentation (More than 72 h Post AMI).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e4.Development of a nomogram.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eWe further prudently used the univariable and multivariable regression analysis results and chose one of the lowest AIC score models to develop the nomogram. The nomogram for PIVSR including LVEF, Cardiogenic Shock, WBC and Revascularization (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) was used to identify patients whose prognosis were likely to be poor. The calibration curve showed a good fit during internal validation, while the HL test showed that our predicted and observed values were close (P\u0026thinsp;=\u0026thinsp;0.939). Our model yielded an AUC value of 0.956 (95% CI 0.912\u0026ndash;1.000) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Meanwhile, The DCA of the nomogram was performed (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Our results showed that our model had a good net clinical benefit in this population.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this multicenter retrospective cohort study, we found that the mortality of PIVSR remained high, was 71.0% (44/62). Meanwhile, we identified that WBC, LVEF, cardiogenic shock were the independent predictors of short-term mortality. Finally, we developed the nomogram for predicting the risk of short-term mortality.\u003c/p\u003e \u003cp\u003ePrevious studies had indicated that leukocyte played an important role in systemic inflammatory reactions, and cardiogenic shock was commonly associated with a severe inflammatory response\u003csup\u003e[\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. The high levels of total WBC count and C-reactive protein (CRP) may be considered as independent prognostic factors in patients with ACS\u003csup\u003e[\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOf note, a significant difference between two groups in LVEF was observed, suggesting an association between relatively low LVEF and increased mortality, even though LVEF in the non-survival group was still within the relatively normal range \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Due to its simplicity and ease of observation, LVEF was one of the indicators traditionally used for the early identification of high-risk patients with AMI\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSchlotter et al. had found that PIVSR complicating AMI frequently leads to cardiogenic shock\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Attia R et al. had reported that the 30-day mortality was 65% with strong correlation with cardiogenic shock\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Our study also confirmed higher mortality in patients who developed cardiogenic shock, emphasizing improving the hemodynamic status of patients during clinical intervention was crucial\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e and the need for early and effective hemodynamic management in this subset of patients.\u003c/p\u003e \u003cp\u003eFurthermore, Phan DQ et al. had reported that revascularization strategies (with either PCI or CABG) were associated with benefit for ACS and all-cause mortality\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. Several studies had indicated that coronary revascularization combined with the closure of rupture might be helpful in improving the prognosis of AMI patients\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Based on these, we chose the revascularization which was significant in univariate analysis as one variable of the nomogram for PIVSR. The size of the rupture and the ICU duration maybe not the predictors for the short-term mortality according to the group comparison analyses. Patients might be considered receiving procedural treatment to improve prognosis rather than consider the size of rupture much more\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e.Few of therapeutic regimens took into account the predicting model for this clinical complication. It was therefore necessary to inform the best-fitting combination of variables, associated with predicting the risk of short-term mortality, for developing an easy-to-use and reliable tool to inform clinical practice. In the present study, we established a nomogram consisting of four predictors including LVEF, cardiogenic shock, WBC count and whether underwent revascularization which can complement and update others already known, such as LVEF and WBC count before PIVSR occurring. Our prediction model was in good agreement with the actual results and performed well in discrimination after internal validation of the model by using multiple indicators during the validation process, including AUC, calibration curve, HL test, AIC and DCA, although we did not conduct an external validation due to the low incidence of PIVSR.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eStudy limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were several limitations in the present study. Although all data were collected retrospectively, selection and recall bias could not be completely prevented, which could sway the final results. The study population was relatively small because of the low incidence of PIVSR in the current era, and the study period was long, which might have limited the number of risk factors associated with the mortality of PIVSR. This was a study from southeast China, therefore expanding the results to other regions might be imprudent.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study described the current status of PIVSR and found the WBC count, cardiogenic shock, and LVEF as the independent predictive factors of short-term mortality. Moreover, the nomogram for PIVSR could provide physicians a new way to screen high-risk patients during early clinical practice, making this special patient population have net clinical benefit eventually.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.395061728395063%\" valign=\"top\"\u003e\n \u003cp\u003ePIVSR\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAMI\u003c/p\u003e\n \u003cp\u003eWBC\u003c/p\u003e\n \u003cp\u003eLVEF\u003c/p\u003e\n \u003cp\u003eACS\u003c/p\u003e\n \u003cp\u003eCHD\u003c/p\u003e\n \u003cp\u003eVIF\u003c/p\u003e\n \u003cp\u003eAUC\u003c/p\u003e\n \u003cp\u003eHL test\u003c/p\u003e\n \u003cp\u003eDCA\u003c/p\u003e\n \u003cp\u003eHF\u003c/p\u003e\n \u003cp\u003ePCI\u003c/p\u003e\n \u003cp\u003eCABG\u003c/p\u003e\n \u003cp\u003eCAG\u003c/p\u003e\n \u003cp\u003eIABP\u003c/p\u003e\n \u003cp\u003eNT-proBNP\u003c/p\u003e\n \u003cp\u003eCTn I\u003c/p\u003e\n \u003cp\u003eAIC\u003c/p\u003e\n \u003cp\u003eCRP\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eECMO\u003c/p\u003e\n \u003cp\u003eTCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.60493827160494%\" valign=\"top\"\u003e\n \u003cp\u003epost-infarction ventricular septal rupture\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eacute myocardial infarction\u003c/p\u003e\n \u003cp\u003ewhite blood cell count\u003c/p\u003e\n \u003cp\u003eleft ventricular ejection fraction\u003c/p\u003e\n \u003cp\u003eAcute Coronary Syndromes\u003c/p\u003e\n \u003cp\u003econgenital heart disease\u003c/p\u003e\n \u003cp\u003evariable inflation factors\u003c/p\u003e\n \u003cp\u003ethe area under the receiver operating curve\u003c/p\u003e\n \u003cp\u003eHosmer Lemeshow goodness of fit test\u003c/p\u003e\n \u003cp\u003edecision curve analysis\u003c/p\u003e\n \u003cp\u003eheart failure\u003c/p\u003e\n \u003cp\u003epercutaneous coronary intervention\u003c/p\u003e\n \u003cp\u003ecoronary artery bypass grafting\u003c/p\u003e\n \u003cp\u003ecoronary angiography\u003c/p\u003e\n \u003cp\u003eintra-aortic balloon pump\u003c/p\u003e\n \u003cp\u003eN-terminal prohormone of brain natriuretic peptide\u003c/p\u003e\n \u003cp\u003ecardiac troponin I\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eakaike information criterion\u003c/p\u003e\n \u003cp\u003eC-reactive protein\u003c/p\u003e\n \u003cp\u003eextracorporeal membrane oxygenation\u003c/p\u003e\n \u003cp\u003etranscatheter closure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and informed consent\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMedical Ethics Committee of the Second Affiliated Hospital of Army Medical University, the First Affiliated Hospital of Army Medical University and the First Affiliated Hospital of Chongqing Medical University approved all consenting procedures.\u0026nbsp;Ethical review number was 2023-NO.031-01. The authors of this manuscript have certified that information contained herein was authentic and dependable. All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Given its retrospective nature, formal consent was not deemed necessary.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWenjian Luo:\u003c/strong\u003e Manuscript writing and data analysis; \u003cstrong\u003eLi Wen:\u003c/strong\u003e Manuscript writing;\u003cstrong\u003e\u0026nbsp;Jinning Zhang:\u003c/strong\u003e Data analysis; \u003cstrong\u003eJunyong Zhao:\u003c/strong\u003e Data collection;\u003cstrong\u003e\u0026nbsp;Zelan Wang:\u003c/strong\u003e Data collection;\u003cstrong\u003e\u0026nbsp;Xiaolin Luo:\u003c/strong\u003e Data collection;\u003cstrong\u003e\u0026nbsp;Shixian Pi:\u003c/strong\u003e Data collection;\u003cstrong\u003e\u0026nbsp;Yang Chen:\u003c/strong\u003e Data collection;\u003cstrong\u003e\u0026nbsp;Jiawen Zhang:\u003c/strong\u003e Data collection;\u003cstrong\u003e\u0026nbsp;Tao Li:\u003c/strong\u003e Data collection;\u003cstrong\u003e\u0026nbsp;Zhihui Zhang:\u003c/strong\u003e Data collection;\u003cstrong\u003e\u0026nbsp;Shiyong Yu:\u003c/strong\u003e Study design and manuscript review;\u003cstrong\u003e\u0026nbsp;Zhexue Qin:\u003c/strong\u003e Study design and manuscript review;\u003cstrong\u003e\u0026nbsp;Dan Luo:\u003c/strong\u003e Study design.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding information is not available.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analyzed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJones BM, Kapadia SR, Smedira NG, Robich M, Tuzcu EM, Menon V et al. Ventricular septal rupture complicating acute myocardial infarction: a contemporary review. Eur Heart J, 35(31). 2014; 2060-68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavid TE. Post-infarction ventricular septal rupture. Annals Cardiothorac Surg, 11(3). 2022; 261\u0026thinsp;\u0026ndash;\u0026thinsp;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkamoto Y, Yamamoto K, Yoshii S. Triple patch technique to repair ventricular septal rupture. Ann Cardiothorac Surg, 11(3). 2022; 273\u0026thinsp;\u0026ndash;\u0026thinsp;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhardwaj A, Kumar S, Salas De Armas IA, Nascimbene A, Nathan S, Kar B, et al. Pre- and post-operative mechanical circulatory support in surgical repair of post-acute myocardial infarction mechanical complications. Ann Cardiothorac Surg. 2022;11(3):304\u0026ndash;09.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGong FF, Vaitenas I, Malaisrie SC, Maganti K. Mechanical Complications of Acute Myocardial Infarction: A Review. JAMA Cardiol, 6(3). 2021; 341\u0026thinsp;\u0026ndash;\u0026thinsp;49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRonco D, Matteucci M, Kowalewski M, De Bonis M, Formica F, Jiritano F et al. Surgical Treatment of Postinfarction Ventricular Septal Rupture. JAMA Netw Open, 4(10). 2021; e2128309.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen T, Liu Y, Zhang J, Sun Z, Cheng J, Han Y et al. Comparison between Cardiac CTA and Echocardiography for Assessment of Ventricular Septal Rupture Diameter and Its Effect on Transcatheter Closure. Cardiovasc Ther, 20222022; 5011286.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRonco D, Matteucci M, Ravaux JM, Marra S, Torchio F, Corazzari C, et al. Mechanical Circulatory Support as a Bridge to Definitive Treatment in Post-Infarction Ventricular Septal Rupture. JACC Cardiovasc Interv. 2021;14(10):1053\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElbadawi A, Elgendy IY, Mahmoud K, Barakat AF, Mentias A, Mohamed AH, et al. Temporal Trends and Outcomes of Mechanical Complications in Patients With Acute Myocardial Infarction. JACC Cardiovasc Interv. 2019;12(18):1825\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArnaoutakis GJ, Zhao Y, George TJ, Sciortino CM, Mccarthy PM, Conte JV. Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg, 94(2). 2012; 436\u0026thinsp;\u0026ndash;\u0026thinsp;43; discussion 43\u0026thinsp;\u0026ndash;\u0026thinsp;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang XY, Bian LZ, Tian NL. The Clinical Outcomes of Ventricular Septal Rupture Secondary to Acute Myocardial Infarction: A Retrospective, Observational Trial. J Interv Cardiol, 20212021; 3900269.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCho JH, Sattiraju S, Mehta S, Missov E. Delayed ventricular septal rupture complicating acute inferior wall myocardial. BMC Res Notes, 2013; 124.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBakhshi H, Gattani R, Ekanem E, Singh R, Desai M, Speir AM et al. Ventricular septal rupture and cardiogenic shock complicating STEMI during COVID-19 pandemic: An old foe re-emerges. Heart Lung, 50(2). 2021; 292\u0026thinsp;\u0026ndash;\u0026thinsp;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArai R, Fukamachi D, Akutsu N, Okumura Y, Tanaka M. Ventricular Septal Rupture After Recent Myocardial Infarction in the Very Elderly. Int Heart J, 61(4). 2020; 831\u0026thinsp;\u0026ndash;\u0026thinsp;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa D, Zhang Z, Zhang S, Wang Z, Zhang G, Wang C et al. Treatment Strategies for Ventricular Septal Rupture After Myocardial Infarction: A Single-Center Experience. Front Cardiovasc Med, 92022; 843625.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang C, Sun Y, Zou D, Sun Z, Zhang X, Su G, et al. Transcatheter closure of ventricular septal rupture with prolonged support of intra-aortic balloon pump after primary PCI: a case report. BMC Cardiovasc Disord. 2021;21(1):605.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrenshaw BS, Granger CB, Birnbaum Y, Pieper KS, Morris DC, Vahanian A et al. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators. Circulation, 1012000; 27\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang L, Xiao LL, Liu C, Zhang YZ, Zhao XY, Li L et al. Clinical Characteristics and Contemporary Prognosis of Ventricular Septal Rupture Complicating Acute Myocardial Infarction: A Single-Center Experience. Front Cardiovasc Med, 82021; 679148.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Diabetes A. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S13\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J, 39(33). 2018; 3021\u0026thinsp;\u0026ndash;\u0026thinsp;104.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVickers AJ, Cronin AM, Elkin EB, Gonen M. Extensions to decision curve analysis, a novel method for evaluating diagnostic tests, prediction models and molecular markers. BMC Med Inf Decis Mak, 2008; 53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAttia R, Blauth C. Which patients might be suitable for a septal occluder device closure of postinfarction ventricular septal rupture rather than immediate surgery? Interact Cardiovasc Thorac Surg. 2010;11(5):626\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThiele H, Kaulfersch C, Daehnert I, Schoenauer M, Eitel I, Borger M et al. Immediate primary transcatheter closure of postinfarction ventricular septal defects. Eur Heart J, 30(1). 2009; 81\u0026thinsp;\u0026ndash;\u0026thinsp;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBradley SM, Borgerding JA, Wood GB, Maynard C, Fihn SD, Incidence. Risk Factors, and Outcomes Associated With In-Hospital Acute Myocardial Infarction. JAMA Netw Open, 2(1). 2019; e187348.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuasti L, Dentali F, Castiglioni L, Maroni L, Marino F, Squizzato A et al. Neutrophils and clinical outcomes in patients with acute coronary syndromes and/or cardiac revascularisation. Thromb Haemost, 106(10). 2017; 591\u0026thinsp;\u0026ndash;\u0026thinsp;99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWheeler J. Associations between differential leucocyte count and incident coronary heart disease: 1764 incident cases from seven prospective studies of 30 374 individuals. Eur Heart J. 2004;25(15):1287\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaminska J, Koper OM, Siedlecka-Czykier E, Matowicka-Karna J, Bychowski J, Kemona H. The utility of inflammation and platelet biomarkers in patients with acute coronary syndromes. Saudi J Biol Sci. 2018;25(7):1263\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBristow MR, Kao DP, Breathett KK, Altman NL, Gorcsan J 3rd, Gill EA et al. Structural and Functional Phenotyping of the Failing Heart: Is the Left Ventricular Ejection Fraction Obsolete? JACC Heart Fail, 5(11). 2017; 772\u0026thinsp;\u0026ndash;\u0026thinsp;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang SM, Huang SC, Wang CH, Wu IH, Chi NH, Yu HY et al. Risk factors and outcome analysis after surgical management of ventricular septal rupture complicating acute myocardial infarction: a retrospective analysis. J Cardiothorac Surg, 102015; 66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchlotter F, De Waha S, Eitel I, Desch S, Fuernau G, Thiele H. Interventional post-myocardial infarction ventricular septal defect closure: a systematic review of current evidence. EuroIntervention. 2016;12(1):94\u0026ndash;102.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHua K, Peng Z, Yang X. Long-Term Survival and Risk Factors for Post-Infarction Ventricular Septal Rupture. Heart Lung Circ, 30(7). 2021; 978\u0026thinsp;\u0026ndash;\u0026thinsp;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhan DQ, Rostomian AH, Schweis F, Chung J, Lin B, Zadegan R, et al. Revascularization Versus Medical Therapy in Patients Aged 80 Years and Older with Acute Myocardial Infarction. J Am Geriatr Soc. 2020;68(11):2525\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEgbe AC, Poterucha JT, Rihal CS, Taggart NW, Cetta F, Cabalka AK, et al. Transcatheter closure of postmyocardial infarction, iatrogenic, and postoperative ventricular septal defects: The Mayo Clinic experience. Catheter Cardiovasc Interv. 2015;86(7):1264\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Risk factor, post-infarction ventricular septal rupture, early mortality","lastPublishedDoi":"10.21203/rs.3.rs-4625058/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4625058/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003ePost-myocardial infarction ventricular septal rupture (PIVSR) is one of the most severe types of mechanical complications after acute myocardial infarction (AMI) with high mortality and poor prognosis. The risk factors for short-term mortality of patients with PIVSR may be not widely recognized. We aimed to assess the prevalence and short-term mortality risk predictors of PIVSR.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 62 patients with a diagnosis of PIVSR were admitted to three top general public hospitals in Chongqing, China. Clinical characteristics and short-term outcomes of patients with PIVSR were compared. Predictors of PIVSR were assessed using logistic regression analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMean age was 70.7\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7 years (38.7% female). The overall in-hospital mortality of PIVSR remained high (71%). Most (47/62) of the patients were in Killip class III or IV at the time of rupture diagnosis. Logistic regression analysis revealed that white blood cell count (WBC, OR 1.619, 95% CI 1.172\u0026ndash;2.237, P\u0026thinsp;=\u0026thinsp;0.005), cardiogenic shock (OR 47.706, 95%CI 2.859-795.945, P\u0026thinsp;=\u0026thinsp;0.007) and left ventricular ejection fraction (LVEF, OR 0.803, 95%CI 0.689\u0026ndash;0.936, P\u0026thinsp;=\u0026thinsp;0.009) were independent risk factors of in-hospital early mortality. The nomogram developed for predicting the risk of short-term mortality showed a robust discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.956 (95%CI 0.912-1.000).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe short-term mortality of PIVSR remained high. WBC, cardiogenic shock, and LVEF were the independent predictive factors of short-term mortality. Our nomogram might be used to predict early mortality of patients with PIVSR.\u003c/p\u003e","manuscriptTitle":"The Short-term Outcomes and Risk Factors of Post-myocardial Infarction Ventricular Septal Rupture: a Multi-center Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-19 20:37:36","doi":"10.21203/rs.3.rs-4625058/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-30T09:35:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-16T23:57:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-10T23:29:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"32628726059439842264384413681726502405","date":"2024-07-02T23:16:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"323023836368163477851398056128972510119","date":"2024-07-02T23:15:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-02T10:01:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-27T23:17:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-27T23:17:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2024-06-23T11:37:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"389eed90-bce5-46bf-a8c5-5f603d4df5b8","owner":[],"postedDate":"July 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-07T16:02:01+00:00","versionOfRecord":{"articleIdentity":"rs-4625058","link":"https://doi.org/10.1186/s13019-024-03077-z","journal":{"identity":"journal-of-cardiothoracic-surgery","isVorOnly":false,"title":"Journal of Cardiothoracic Surgery"},"publishedOn":"2024-10-01 15:57:38","publishedOnDateReadable":"October 1st, 2024"},"versionCreatedAt":"2024-07-19 20:37:36","video":"","vorDoi":"10.1186/s13019-024-03077-z","vorDoiUrl":"https://doi.org/10.1186/s13019-024-03077-z","workflowStages":[]},"version":"v1","identity":"rs-4625058","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4625058","identity":"rs-4625058","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}