Early thrombolysis is associated with decreased operative mortality in postinfarction ventricular septal ruptureKey questions
Background: Post myocardial infarction ventricular septal rupture (PMI-VSR) is a dreaded mechanical complication of acute coronary syndromes. Given that surgical mortality approaches 50%, it is pragmatic that the risk factors for mortality and outcomes after surgical correction of PMI- VSR are caref...
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| Format: | Article |
| Language: | English |
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Elsevier
2019-05-01
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| Series: | Indian Heart Journal |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0019483219300720 |
| _version_ | 1818999757760102400 |
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| author | Neeti Dogra Goverdhan Dutt Puri Shyam K.S. Thingnam V.K. Arya Bhupesh Kumar Sachin Mahajan Madhur Verma |
| author_facet | Neeti Dogra Goverdhan Dutt Puri Shyam K.S. Thingnam V.K. Arya Bhupesh Kumar Sachin Mahajan Madhur Verma |
| author_sort | Neeti Dogra |
| collection | DOAJ |
| description | Background: Post myocardial infarction ventricular septal rupture (PMI-VSR) is a dreaded mechanical complication of acute coronary syndromes. Given that surgical mortality approaches 50%, it is pragmatic that the risk factors for mortality and outcomes after surgical correction of PMI- VSR are carefully scrutinized. Methods: We performed a single-center, retrospective cohort study of 35 patients presenting for surgical closure of post myocardial infarction ventricular septal rupture over six years. We reviewed patient characteristics, clinical, echocardiographic, angiographic and perioperative risk factors which may affect mortality after surgical repair of PMIVSR and 30 day and one year mortality rates of these patients. Univariate and multivariate logistic and cox proportional hazard regression analysis was used to identify predictors of operative and overall mortality. Long term survival was presented with Kaplan-Meier Survival Curve. Results: Sixteen patients (46%) were in cardiogenic shock. Concomitant coronary artery bypass grafting (CABG) was done in 22 patients (63%) but did not influence survival. Preoperative thrombolysis was done in 12 patients (34%) out of which 10 (53%) survived Operative mortality was 46% and one-year mortality was 49%. Multivariate analysis identified preoperative thrombolysis: Hazards ratio, 0.12; 95% CI, 0.02-0.61; p value of 0.01, as significant independent predictor of survival in PMIVSR cohort. Conclusions: Preoperative thrombolysis is associated with decreased odds of operative and overall mortality after surgical repair in PMIVSR patients. Keywords: Post–myocardial infarction, Ventricular septal rupture, Early thrombolysis, Risk factors, Outcomes |
| first_indexed | 2024-12-20T22:22:30Z |
| format | Article |
| id | doaj.art-72a1983c5dca48fd931534b8560d7429 |
| institution | Directory Open Access Journal |
| issn | 0019-4832 |
| language | English |
| last_indexed | 2024-12-20T22:22:30Z |
| publishDate | 2019-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Indian Heart Journal |
| spelling | doaj.art-72a1983c5dca48fd931534b8560d74292022-12-21T19:24:53ZengElsevierIndian Heart Journal0019-48322019-05-01713224228Early thrombolysis is associated with decreased operative mortality in postinfarction ventricular septal ruptureKey questionsNeeti Dogra0Goverdhan Dutt Puri1Shyam K.S. Thingnam2V.K. Arya3Bhupesh Kumar4Sachin Mahajan5Madhur Verma6Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India; Corresponding author.Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, IndiaDepartment of Cardiothoracic and Vascular Surgery, PGIMER, Chandigarh, IndiaDepartment of Anesthesia and Intensive Care, PGIMER, Chandigarh, IndiaDepartment of Anesthesia and Intensive Care, PGIMER, Chandigarh, IndiaDepartment of Cardiothoracic and Vascular Surgery, PGIMER, Chandigarh, IndiaDepartment of Community Medicine and School of Public Health, PGIMER, Chandigarh, IndiaBackground: Post myocardial infarction ventricular septal rupture (PMI-VSR) is a dreaded mechanical complication of acute coronary syndromes. Given that surgical mortality approaches 50%, it is pragmatic that the risk factors for mortality and outcomes after surgical correction of PMI- VSR are carefully scrutinized. Methods: We performed a single-center, retrospective cohort study of 35 patients presenting for surgical closure of post myocardial infarction ventricular septal rupture over six years. We reviewed patient characteristics, clinical, echocardiographic, angiographic and perioperative risk factors which may affect mortality after surgical repair of PMIVSR and 30 day and one year mortality rates of these patients. Univariate and multivariate logistic and cox proportional hazard regression analysis was used to identify predictors of operative and overall mortality. Long term survival was presented with Kaplan-Meier Survival Curve. Results: Sixteen patients (46%) were in cardiogenic shock. Concomitant coronary artery bypass grafting (CABG) was done in 22 patients (63%) but did not influence survival. Preoperative thrombolysis was done in 12 patients (34%) out of which 10 (53%) survived Operative mortality was 46% and one-year mortality was 49%. Multivariate analysis identified preoperative thrombolysis: Hazards ratio, 0.12; 95% CI, 0.02-0.61; p value of 0.01, as significant independent predictor of survival in PMIVSR cohort. Conclusions: Preoperative thrombolysis is associated with decreased odds of operative and overall mortality after surgical repair in PMIVSR patients. Keywords: Post–myocardial infarction, Ventricular septal rupture, Early thrombolysis, Risk factors, Outcomeshttp://www.sciencedirect.com/science/article/pii/S0019483219300720 |
| spellingShingle | Neeti Dogra Goverdhan Dutt Puri Shyam K.S. Thingnam V.K. Arya Bhupesh Kumar Sachin Mahajan Madhur Verma Early thrombolysis is associated with decreased operative mortality in postinfarction ventricular septal ruptureKey questions Indian Heart Journal |
| title | Early thrombolysis is associated with decreased operative mortality in postinfarction ventricular septal ruptureKey questions |
| title_full | Early thrombolysis is associated with decreased operative mortality in postinfarction ventricular septal ruptureKey questions |
| title_fullStr | Early thrombolysis is associated with decreased operative mortality in postinfarction ventricular septal ruptureKey questions |
| title_full_unstemmed | Early thrombolysis is associated with decreased operative mortality in postinfarction ventricular septal ruptureKey questions |
| title_short | Early thrombolysis is associated with decreased operative mortality in postinfarction ventricular septal ruptureKey questions |
| title_sort | early thrombolysis is associated with decreased operative mortality in postinfarction ventricular septal rupturekey questions |
| url | http://www.sciencedirect.com/science/article/pii/S0019483219300720 |
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