Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction

• Published in: Circulation (New York, N.Y.) N.Y.), 2000-01, Vol.101 (1), p.27-32
• Main Authors: CRENSHAW, B. S, GRANGER, C. B, BIRNBAUM, Y, PIEPER, K. S, MORRIS, D. C, KLEIMAN, N. S, VAHANIAN, A, CALIFF, R. M, TOPOL, E. J
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Medical sciences; Pharmacology. Drug treatments
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.101.1.27

Background —Ventricular septal defect (VSD) complicating acute myocardial infarction has been studied primarily in small, prethrombolytic-era trials. Our goal was to determine clinical predictors and angiographic and clinical outcomes of this complication in the thrombolytic era. Methods and Results —We compared enrollment characteristics, angiographic patterns, and outcomes (30-day and 1-year mortality) of patients enrolled in the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries (GUSTO-I) trial with and without a confirmed diagnosis of VSD. Univariable and multivariable analyses were used to assess relations between enrollment factors and the development of VSD. In all, 84 of the 41 021 patients (0.2%) developed VSD, a smaller percentage than reported in the prethrombolytic era. The median time from symptom onset to VSD diagnosis was 1 day. Enrollment factors most associated with this complication were advanced age, anterior infarction, female sex, and no previous smoking. The infarct artery was more often the left anterior descending and more likely to be totally occluded in patients who developed VSD. Mortality at 30 days was higher in patients with VSDs than in those without this complication (73.8% versus 6.8%, P