Factors Associated With 30-Day Mortality in Patients With Post-Myocardial Infarction Ventricular Septal Rupture: A Retrospective Cohort Study

Background: Post-myocardial infarction ventricular septal rupture is associated with high mortality, and comparative outcome data across contemporary treatment strategies remain limited. We aimed to identify factors associated with 30-day mortality, compare observed outcomes across four treatment strategies, including surgical repair combining an occluder and a patch (SurCOP), and develop an internally validated multivariable model incorporating the treatment ultimately received for retrospective prognostic assessment.

Methods: Between May 2012 and October 2025, 214 patients with post-myocardial infarction ventricular septal rupture (VSR) were included and classified according to 30-day survival status. Baseline characteristics, clinical presentations, and treatment strategies, including conservative medical therapy, transcatheter closure, traditional surgical repair, and SurCOP, were compared. Univariable and multivariable logistic regression analyses were performed to identify factors associated with 30-day mortality. The prognostic model was developed in a 187-patient complete-case cohort defined before variable selection. Model discrimination was assessed using receiver operating characteristic curve analysis, and internal validation was performed using stratified 10-fold cross-validation and bootstrap optimism correction with 500 resamples.

Results: Among the 214 enrolled patients with VSR, the overall 30-day mortality rate was 51.9%. Notably, observed 30-day mortality was lowest in the SurCOP group (21.8%), although treatment-group comparisons should be interpreted in light of non-random treatment allocation. Among the 123 patients who underwent a definitive invasive intervention, the median interval from VSR diagnosis to treatment differed among the SurCOP, traditional surgical repair, and transcatheter closure groups (6.5, 31.4, and 17.8 days, respectively; P<0.001). Multivariable logistic regression analysis revealed that conservative medical therapy was associated with a higher odds of mortality compared to the SurCOP technique (odds ratio [OR], 27.822). Additionally, elevated admission creatinine (OR, 1.010) and lactate (OR, 1.337) were independently associated with higher 30-day mortality. Conversely, a history of angina pectoris or myocardial infarction (OR, 0.235) was independently associated with lower 30-day mortality. A retrospective prognostic model incorporating the treatment ultimately received was subsequently constructed. The model demonstrated good discriminatory performance, with an apparent area under the receiver operating characteristic curve (AUC) of 0.906 (95% confidence interval (CI), 0.863–0.948), a sensitivity of 0.768, and a specificity of 0.943. Stratified 10-fold cross-validation yielded an AUC of 0.875 (95% CI, 0.825–0.925), and the bootstrap optimism-corrected AUC was 0.884.

Conclusions: In this retrospective single-center cohort, treatment modality, admission creatinine, admission lactate, and a history of angina or myocardial infarction were associated with 30-day mortality. The combined model showed good apparent discrimination and retained acceptable discrimination after internal validation. Because treatment allocation was non-random and the model incorporated the treatment ultimately received, the findings should be interpreted as prognostic associations and require external validation before clinical application.