Objectives: Ventricular septal rupture (VSR) is a rare but lethal complication of acute myocardial infarction (AMI). We conducted a retrospective analysis of the clinical characteristics of VSR patients and explored the risk factors for long-term mortality.

Methods: In this single-center cohort study, 127 patients diagnosed with post-AMI VSR between May 2012 and April 2019 were included. Demographic, clinical, operative, and outcome data were collected. The 30-day and long-term mortality were outcomes of interest. Cox proportional hazard regression analysis was used to explore the predictors of long-term mortality.

Results: The mean age of the VSR cohort was 66.6 ± 8.7 years, 67 (52.8%) were males. Among the 127 patients, 78 patients (61.4%) were medically managed, 31 (24.4%) patients underwent percutaneous transcatheter closure (TCC), and 18 (14.2%) patients received surgical repair. The median follow-up time was 1129 days [interquartile range: 802–2019 days]. The 30-day mortality of the medically managed group, percutaneous TCC group, and surgical management group was 93.6, 22.6, and 11.1%, respectively; and the long-term mortality was 96.2, 25.8, and 22.2%, respectively. VSR repair treatment including surgical management (HR 0.01, 95% CI 0.001–0.09, p < 0.001) and percutaneous TCC (HR 0.09, 95% CI 0.03–0.26, p < 0.001) was associated with a better prognosis, and cardiogenic shock (CS) (HR 9.30, 95% CI 3.38–25.62, p < 0.001) was an independent risk factor of long-term mortality.

Conclusions: The prognosis of VSR patients without operative management remains poor, especially in those complicated with CS. Timely and improved surgery treatment is needed for better outcomes in VSR patients.

目标：室间隔破裂 (VSR) 是急性心肌梗死 (AMI) 的一种罕见但致命的并发症。我们对 VSR 患者的临床特征进行了回顾性分析，并探讨了长期死亡率的危险因素。

方法：在这项单中心队列研究中，纳入了 2012 年 5 月至 2019 年 4 月期间诊断为 AMI 后 VSR 的 127 名患者。收集了人口统计学、临床、手术和结果数据。30 天和长期死亡率是感兴趣的结果。Cox 比例风险回归分析用于探索长期死亡率的预测因素。

结果：VSR 队列的平均年龄为 66.6 ± 8.7 岁，其中 67 人（52.8%）为男性。在 127 名患者中，78 名患者（61.4%）接受了药物治疗，31 名（24.4%）患者接受了经皮经导管封堵术（TCC），18 名（14.2%）患者接受了手术修复。中位随访时间为 1129 天 [四分位距：802-2019 天]。药物治疗组、经皮TCC组和手术治疗组的30天死亡率分别为93.6%、22.6%和11.1%；远期病死率分别为 96.2%、25.8% 和 22.2%。VSR 修复治疗，包括手术治疗（HR 0.01，95% CI 0.001–0.09，磷 < 0.001) 和经皮 TCC（HR 0.09，95% CI 0.03–0.26， 磷 < 0.001) 与更好的预后相关，心源性休克 (CS) (HR 9.30, 95% CI 3.38–25.62, 磷 < 0.001) 是长期死亡率的独立危险因素。

结论：没有手术治疗的 VSR 患者的预后仍然很差，尤其是那些并发 CS 的患者。VSR 患者需要及时和改进的手术治疗才能获得更好的结果。