title: Ventricular Septal Defect Complicating ST-Elevation Myocardial Infarctions: A Call for Action.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Interventional Cardiology, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston. Electronic address: vikas.dr.singh@gmail.com.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: Cardiovascular Division, University of Miami, Miller School of Medicine, Fla.
authors.forename: Alex P
authors.initials: AP
authors.lastname: Rodriguez
authors.affiliation: Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock.
authors.forename: Parth
authors.initials: P
authors.lastname: Bhatt
authors.affiliation: Cardiovascular Division, University of Miami, Miller School of Medicine, Fla.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Alfonso
authors.affiliation: Interventional Cardiology, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Rahul
authors.initials: R
authors.lastname: Sakhuja
authors.affiliation: Interventional Cardiology, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Igor F
authors.initials: IF
authors.lastname: Palacios
authors.affiliation: Interventional Cardiology, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Inglessis-Azuaje
authors.affiliation: Cardiovascular Division, University of Miami, Miller School of Medicine, Fla.
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
authors.affiliation: Interventional Cardiology, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Sammy
authors.initials: S
authors.lastname: Elmariah
authors.affiliation: Division of Cardiology, Henry Ford Hospital, Detroit, Mich.
authors.forename: William W
authors.initials: WW
authors.lastname: O'Neill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000150:complications* / Q000401:mortality* / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D000072657:ST Elevation Myocardial Infarction / Q000150:complications* / Q000401:mortality* / Q000601:surgery; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Acute complication; Myocardial infarction; Surgical intervention; Ventricular septal defect