POST MYOCARDIAL INFARCTION VENTRICULAR SEPTAL RUPTURE AND FACTORS ASSOCIATED WITH ITS MORTALITY: A RETROSPECTIVE STUDY

OBJECTIVES: To determine the incidence of ventricular septal rupture (VSR) following acute myocardial infarction (AMI) and to find out factors associated with its mortality. METHODS: This retrospective study was done at Lady Reading Hospital, Peshawar, Pakistan in which 03years (January-2014 to December-2016) data of AMI patients was studied. Patients with VSR after AMI, diagnosed on echocardiography were included. Chi-square test was applied to correlate cardiovascular risk factors and clinical parameters with the mortality in post-MI VSR patients. RESULTS: A data of 6240 patients with AMI was analyzed in which 60 patients had VSR (incidence rate of 0.96%) with 64.7% having acute anterior MI. It is 8.5 times greater in first-MI and have a delayed onset. Twenty-six patients were excluded due to presence of concomitant complications and rest of 34 werestudied in detail. Mean age of post-MI VSR patients was 63.21±8.9years, among them 52.9% were males. Mean time of development of VSR was 4.1±2.2days with the minimum of 01day and maximum of 10days after diagnosis of AMI. Nineteen patients (55.9%) didn t receive streptokinase. The mortality rate was 38.2% which was significantly associated with diabetes, tachycardia, shock, high Killip class, renal impairment and multiple VSR s (P-value of 0.012, 0.021, 0.032, 0.031, 0.036 and 0.016 respectively). CONCLUSIONS: VSR incidence after AMI in our study was 0.96% with 8.5 times greater in first-MI and have a delayed onset. Diabetes mellitus, multiple lesions, presence of shock, tachycardia, renal impairment and high Killip class after development of VSR are associated with high mortality.