Study aim: Exploring the optimal timing of interventional closure for ventricular septal rupture after acute myocardial infarction

Abstract: This retrospective case series study investigates the optimal timing for percutaneous occlusion treatment in patients with ventricular septal rupture following acute myocardial infarction. The study compiled clinical data and prognosis of 69 and 81 patients from Henan Provincial People's Hospital and Fuwai Central China Cardiovascular Hospital, making it one of the largest single-center studies worldwide. Analysis via ROC curve method identified 21.5 days post-myocardial infarction as the optimal time for intervention. Additionally, the study examined the effectiveness and complications of occlusion treatment, finding a 94.2% success rate, an in-hospital mortality rate of 18.8%, and a 30-day postoperative mortality rate of 23.2%. Successful occlusion resulted in improved pulmonary/systemic blood flow ratio, decreased pulmonary artery pressure, increased aortic pressure and left ventricular EF, and improved NYHA functional classification. The study also identified C-reactive protein and BNP levels as significant independent risk factors for early postoperative death, highlighting the importance of considering patient-specific conditions when selecting the timing for occlusion treatment.

Research comments: Ventricular septal rupture is a severe complication of acute myocardial infarction with a high mortality rate. Currently, there is a lack of large-scale clinical research on its treatment globally, and there's no consensus on the optimal timing for occlusion treatment. If occlusion is performed too early, the myocardial tissue at the perforation site may not be sufficiently fibrotic, leading to unstable or displaced occluders. If done too late, patients risk exacerbated heart failure and losing the opportunity for surgery. Dr. Chen Tongfeng and his team analyzed 69 and 81 cases, the largest single-center sample to date, and found that the best timing for occlusion is 21.5 days post-myocardial infarction. This research provides a crucial time window for intervention, helping to improve treatment success rates, reduce postoperative complications, and enhance overall patient prognosis. The study fills a research gap and offers valuable clinical experience and data, also examining various factors affecting surgical outcomes and patient prognosis, guiding future research and clinical treatments.