Epidemiological profile and clinical characteristics of patients with post myocardial infarction ventricular septal rupture: insights from a brazilian cohort

Ventricular septal rupture (VSR) is an infrequent but devastating mechanical complication of acute myocardial infarction (AMI), currently affecting less than 1% of infarctions but still carrying mortality rates above 50%. It usually develops in extensive transmural necrosis, delayed reperfusion, or multivessel disease. Understanding the epidemiological and clinical features of these patients is crucial to identify high risk groups, design preventive interventions, and evaluate the real world impact of this complication.

To describe the demographic, clinical, laboratory, and angiographic characteristics of patients with VSR secondary to AMI managed in a tertiary brazilian cardiac center.

This single‑center retrospective observational study included 59 patients with post‑AMI VSR from 2000 to 2024. Demographic data, cardiovascular risk factors, laboratory variables, left ventricular function, angiographic findings and use of mechanical circulatory support were reviewed. Descriptive statistics included frequencies, mean, standard deviation, median, and interquartile range. Analyses were performed using R software (v4.2.2).

Mean age was 65.3 ± 10.2 years and 57.6% were male. Hypertension occurred in 71.2%, dyslipidemia in 50.8%, diabetes mellitus in 35.6%, active smoking in 57.6% and previous coronary artery disease in 74.6%. Mean left‑ventricular ejection fraction was 0.43 ± 0.10, and mean serum creatinine 1.39 ± 0.82 mg/dL. Mean admission lactate and BNP levels were 2.02 ± 2.36 mmol/L (n=16) and 7,564 ± 9,066 pg/mL (n=16), respectively. Median time from symptom onset to hospital admission was 8 days [IQR 1–26], and from symptom onset to surgery 15 days [IQR 7–37]. The left anterior descending artery was the most frequently involved vessel (62%), followed by the right coronary artery (53%) and circumflex artery (11%). Intra‑aortic balloon pump support was used in 64.4% of cases (33.9% preoperative and 30.5% postoperative). Renal replacement therapy was required in 17.2% and a Swan‑Ganz catheter was used in 54.5%. In-hospital mortality was 54.4%, whereas both 30-day and six-month survival were 53.6% among operated patients, indicating identical short- and mid-term outcomes.

Patients who develop VSR after AMI are predominantly male, of older age, hypertensive, smokers, with multiple associated comorbidities. They present moderate left ventricular dysfunction and significant delay between the ischemic event and surgical repair, reflecting the severity and complexity of these cases. The epidemiological characterization of this population reinforces the importance of early recognition and intensive management of cardiovascular risk factors to reduce the occurrence of this devastating complication in the setting of acute myocardial infarction.