Ventricular Septal Defect Complicating ST-Elevation Myocardial Infarctions: A Call for Action

Vikas Singh, Alex P. Rodriguez, Parth Bhatt, Carlos E Alfonso, Rahul Sakhuja, Igor F. Palacios, Ignacio Inglessis-Azuaje, Mauricio G Cohen, Sammy Elmariah, William W. O'Neill

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Ventricular septal defect is a lethal complication after an acute myocardial infarction, which has become infrequent with the advent of reperfusion strategies; however, it remains a major contributor to mortality. Methods: We identified patients using the International Classification of Diseases, 9th Revision, Clinical Modification procedure codes from the Nationwide Inpatient Sample between the years 2001 and 2013. A multivariate hierarchical logistic regression model was used to identify significant predictors of in-hospital mortality. Results: We identified 3,373,206 ST-elevation myocardial infarctions, out of which 10,012 (0.3%) were complicated with ventricular septal defects. Most of the patients (60%) were older than 65 years, male (55%), and white (63%). Inferior (49.7%) and anterior (41.1%) myocardial infarctions were more commonly implicated with the development of ventricular septal defects. The median (interquartile range) hospitalization length was 7 (3.0-13.5) days. Only 7.65% of patients underwent some intervention, with 7% surgical and 0.65% minimally invasive. Mechanical support devices were used in 36.5% of patients, with intra-aortic balloon pump (96%) being the most common. In-hospital mortality remained high at 30.5% (downward trending from 41.6% in 2001 to 23.3% in 2013). Age, cardiogenic shock, and in-hospital cardiac arrest were statistically significant predictors of in-hospital mortality. The utilization of corrective procedures significantly declined. The use of mechanical support devices and performing a corrective procedure were associated with higher mortality, length of stay, and cost. Conclusions: Ventricular septal defects after acute myocardial infarctions remain associated with significantly high mortality rates. Highly specialized regional centers with individual expertise in the management of septal ruptures are required to improve outcomes of these patients.

Original languageEnglish (US)
JournalAmerican Journal of Medicine
DOIs
StateAccepted/In press - 2017

Fingerprint

Ventricular Heart Septal Defects
Hospital Mortality
Myocardial Infarction
Mortality
Logistic Models
Equipment and Supplies
Cardiogenic Shock
International Classification of Diseases
Heart Arrest
Reperfusion
Inpatients
Rupture
Length of Stay
Hospitalization
ST Elevation Myocardial Infarction
Costs and Cost Analysis

Keywords

  • Acute complication
  • Myocardial infarction
  • Surgical intervention
  • Ventricular septal defect

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Ventricular Septal Defect Complicating ST-Elevation Myocardial Infarctions : A Call for Action. / Singh, Vikas; Rodriguez, Alex P.; Bhatt, Parth; Alfonso, Carlos E; Sakhuja, Rahul; Palacios, Igor F.; Inglessis-Azuaje, Ignacio; Cohen, Mauricio G; Elmariah, Sammy; O'Neill, William W.

In: American Journal of Medicine, 2017.

Research output: Contribution to journalArticle

Singh, Vikas ; Rodriguez, Alex P. ; Bhatt, Parth ; Alfonso, Carlos E ; Sakhuja, Rahul ; Palacios, Igor F. ; Inglessis-Azuaje, Ignacio ; Cohen, Mauricio G ; Elmariah, Sammy ; O'Neill, William W. / Ventricular Septal Defect Complicating ST-Elevation Myocardial Infarctions : A Call for Action. In: American Journal of Medicine. 2017.
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title = "Ventricular Septal Defect Complicating ST-Elevation Myocardial Infarctions: A Call for Action",
abstract = "Background: Ventricular septal defect is a lethal complication after an acute myocardial infarction, which has become infrequent with the advent of reperfusion strategies; however, it remains a major contributor to mortality. Methods: We identified patients using the International Classification of Diseases, 9th Revision, Clinical Modification procedure codes from the Nationwide Inpatient Sample between the years 2001 and 2013. A multivariate hierarchical logistic regression model was used to identify significant predictors of in-hospital mortality. Results: We identified 3,373,206 ST-elevation myocardial infarctions, out of which 10,012 (0.3{\%}) were complicated with ventricular septal defects. Most of the patients (60{\%}) were older than 65 years, male (55{\%}), and white (63{\%}). Inferior (49.7{\%}) and anterior (41.1{\%}) myocardial infarctions were more commonly implicated with the development of ventricular septal defects. The median (interquartile range) hospitalization length was 7 (3.0-13.5) days. Only 7.65{\%} of patients underwent some intervention, with 7{\%} surgical and 0.65{\%} minimally invasive. Mechanical support devices were used in 36.5{\%} of patients, with intra-aortic balloon pump (96{\%}) being the most common. In-hospital mortality remained high at 30.5{\%} (downward trending from 41.6{\%} in 2001 to 23.3{\%} in 2013). Age, cardiogenic shock, and in-hospital cardiac arrest were statistically significant predictors of in-hospital mortality. The utilization of corrective procedures significantly declined. The use of mechanical support devices and performing a corrective procedure were associated with higher mortality, length of stay, and cost. Conclusions: Ventricular septal defects after acute myocardial infarctions remain associated with significantly high mortality rates. Highly specialized regional centers with individual expertise in the management of septal ruptures are required to improve outcomes of these patients.",
keywords = "Acute complication, Myocardial infarction, Surgical intervention, Ventricular septal defect",
author = "Vikas Singh and Rodriguez, {Alex P.} and Parth Bhatt and Alfonso, {Carlos E} and Rahul Sakhuja and Palacios, {Igor F.} and Ignacio Inglessis-Azuaje and Cohen, {Mauricio G} and Sammy Elmariah and O'Neill, {William W.}",
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T1 - Ventricular Septal Defect Complicating ST-Elevation Myocardial Infarctions

T2 - A Call for Action

AU - Singh, Vikas

AU - Rodriguez, Alex P.

AU - Bhatt, Parth

AU - Alfonso, Carlos E

AU - Sakhuja, Rahul

AU - Palacios, Igor F.

AU - Inglessis-Azuaje, Ignacio

AU - Cohen, Mauricio G

AU - Elmariah, Sammy

AU - O'Neill, William W.

PY - 2017

Y1 - 2017

N2 - Background: Ventricular septal defect is a lethal complication after an acute myocardial infarction, which has become infrequent with the advent of reperfusion strategies; however, it remains a major contributor to mortality. Methods: We identified patients using the International Classification of Diseases, 9th Revision, Clinical Modification procedure codes from the Nationwide Inpatient Sample between the years 2001 and 2013. A multivariate hierarchical logistic regression model was used to identify significant predictors of in-hospital mortality. Results: We identified 3,373,206 ST-elevation myocardial infarctions, out of which 10,012 (0.3%) were complicated with ventricular septal defects. Most of the patients (60%) were older than 65 years, male (55%), and white (63%). Inferior (49.7%) and anterior (41.1%) myocardial infarctions were more commonly implicated with the development of ventricular septal defects. The median (interquartile range) hospitalization length was 7 (3.0-13.5) days. Only 7.65% of patients underwent some intervention, with 7% surgical and 0.65% minimally invasive. Mechanical support devices were used in 36.5% of patients, with intra-aortic balloon pump (96%) being the most common. In-hospital mortality remained high at 30.5% (downward trending from 41.6% in 2001 to 23.3% in 2013). Age, cardiogenic shock, and in-hospital cardiac arrest were statistically significant predictors of in-hospital mortality. The utilization of corrective procedures significantly declined. The use of mechanical support devices and performing a corrective procedure were associated with higher mortality, length of stay, and cost. Conclusions: Ventricular septal defects after acute myocardial infarctions remain associated with significantly high mortality rates. Highly specialized regional centers with individual expertise in the management of septal ruptures are required to improve outcomes of these patients.

AB - Background: Ventricular septal defect is a lethal complication after an acute myocardial infarction, which has become infrequent with the advent of reperfusion strategies; however, it remains a major contributor to mortality. Methods: We identified patients using the International Classification of Diseases, 9th Revision, Clinical Modification procedure codes from the Nationwide Inpatient Sample between the years 2001 and 2013. A multivariate hierarchical logistic regression model was used to identify significant predictors of in-hospital mortality. Results: We identified 3,373,206 ST-elevation myocardial infarctions, out of which 10,012 (0.3%) were complicated with ventricular septal defects. Most of the patients (60%) were older than 65 years, male (55%), and white (63%). Inferior (49.7%) and anterior (41.1%) myocardial infarctions were more commonly implicated with the development of ventricular septal defects. The median (interquartile range) hospitalization length was 7 (3.0-13.5) days. Only 7.65% of patients underwent some intervention, with 7% surgical and 0.65% minimally invasive. Mechanical support devices were used in 36.5% of patients, with intra-aortic balloon pump (96%) being the most common. In-hospital mortality remained high at 30.5% (downward trending from 41.6% in 2001 to 23.3% in 2013). Age, cardiogenic shock, and in-hospital cardiac arrest were statistically significant predictors of in-hospital mortality. The utilization of corrective procedures significantly declined. The use of mechanical support devices and performing a corrective procedure were associated with higher mortality, length of stay, and cost. Conclusions: Ventricular septal defects after acute myocardial infarctions remain associated with significantly high mortality rates. Highly specialized regional centers with individual expertise in the management of septal ruptures are required to improve outcomes of these patients.

KW - Acute complication

KW - Myocardial infarction

KW - Surgical intervention

KW - Ventricular septal defect

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