Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio.
Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio.
Am J Cardiol. 2022 Jul 15;175:44-51. doi: 10.1016/j.amjcard.2022.04.017. Epub 2022 May 18.
The optimal timing of postinfarction ventricular septal defect (PI-VSD) repair is subject to debate. Patients with ventricular septal defect (VSD) and ST-elevation myocardial infarction (STEMI) were queried using appropriate International Classification of Diseases, Ninth and Tenth Revision Clinical Modification codes from the National Inpatient Sample (2003 to 2018). VSD repair was identified using appropriate International Classification of Diseases, Ninth and Tenth Revision Procedure Coding System codes. Data were stepwise stratified by cardiogenic shock (CS) and time of repair from admission to create 6 clinically relevant groups: shock 1 (CS; 0 to 7 days), shock 2 (CS; 8 to 14 days), and shock 3 (CS; >14 days). Nonshock groups were classified similarly. The primary outcome was in-hospital mortality. Multilevel hierarchical logistic regression was used to adjust for confounders for each group. We identified 10,902 patients with PI-VSD. In shock 1 (n = 5,794), VSD repair was associated with lower mortality (OR 0.76; 95% CI 0.68 to 0.86, p <0.001) compared to no VSD repair. In shock 2 (n=1,009) mortality was numerically lower in those who received VSD repair, but not statistically different. In shock 3 (n=483), mortality was numerically higher in those who received VSD repair, but not statistically different. In nonshock 1 (n=5,108), VSD repair was associated with higher mortality (odds ratio [OR] 1.59; 95% confidence interval [CI] 1.33 to 1.90; p <0.001). In nonshock 2 (n = 1,265), mortality was numerically higher in patients with VSD repair, although not statistically different. In nonshock 3 (n = 472), mortality was numerically lower in patients with VSD repair, although not statistically different. Mechanical circulatory support use increased over the 16 years (relative change + 18%, p <0.001), with no significant change in mortality among patients with PI-VSD. In conclusion, in patients with CS, early PI-VSD repair was associated with lower mortality. However, in patients without CS, early PI-VSD repair was associated with higher mortality.
心肌梗死后室间隔缺损（PI-VSD）修复的最佳时机仍存在争议。本研究通过适当的国际疾病分类、第九和第十修订版临床修正代码（2003 年至 2018 年），从国家住院患者样本（National Inpatient Sample，NIS）中查询患有室间隔缺损（VSD）和 ST 段抬高型心肌梗死（STEMI）的患者。使用适当的国际疾病分类、第九和第十修订版手术操作分类系统代码来识别 VSD 修复。根据心源性休克（CS）和从入院到修复的时间，逐步对数据进行分层，创建 6 个具有临床意义的组：休克 1（CS；0 至 7 天）、休克 2（CS；8 至 14 天）和休克 3（CS；>14 天）。非休克组也类似地进行分类。主要结局为住院死亡率。使用多层次分层逻辑回归来调整每组的混杂因素。我们共确定了 10902 例 PI-VSD 患者。在休克 1 组（n=5794）中，与未行 VSD 修复相比，VSD 修复与较低的死亡率相关（比值比 0.76；95%置信区间 0.68 至 0.86，p<0.001）。在休克 2 组（n=1009）中，接受 VSD 修复的患者死亡率虽较低，但无统计学差异。在休克 3 组（n=483）中，接受 VSD 修复的患者死亡率虽较高，但无统计学差异。在非休克 1 组（n=5108）中，VSD 修复与较高的死亡率相关（比值比 1.59；95%置信区间 1.33 至 1.90；p<0.001）。在非休克 2 组（n=1265）中，尽管 VSD 修复的患者死亡率虽较高，但无统计学差异。在非休克 3 组（n=472）中，接受 VSD 修复的患者死亡率虽较低，但无统计学差异。16 年来，机械循环支持的使用增加（相对变化+18%，p<0.001），但 PI-VSD 患者的死亡率没有明显变化。总之，在 CS 患者中，早期 PI-VSD 修复与较低的死亡率相关。然而，在没有 CS 的患者中，早期 PI-VSD 修复与较高的死亡率相关。
