{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T21:08:53Z","timestamp":1794344933207,"version":"4.9.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2000,1,4]]},"abstract":"<jats:p>\n                    <jats:italic>Background<\/jats:italic>\n                    \u2014Ventricular septal defect (VSD) complicating acute myocardial infarction has been studied primarily in small, prethrombolytic-era trials. Our goal was to determine clinical predictors and angiographic and clinical outcomes of this complication in the thrombolytic era.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Methods and Results<\/jats:italic>\n                    \u2014We compared enrollment characteristics, angiographic patterns, and outcomes (30-day and 1-year mortality) of patients enrolled in the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries (GUSTO-I) trial with and without a confirmed diagnosis of VSD. Univariable and multivariable analyses were used to assess relations between enrollment factors and the development of VSD. In all, 84 of the 41 021 patients (0.2%) developed VSD, a smaller percentage than reported in the prethrombolytic era. The median time from symptom onset to VSD diagnosis was 1 day. Enrollment factors most associated with this complication were advanced age, anterior infarction, female sex, and no previous smoking. The infarct artery was more often the left anterior descending and more likely to be totally occluded in patients who developed VSD. Mortality at 30 days was higher in patients with VSDs than in those without this complication (73.8% versus 6.8%,\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.001). Patients with VSDs selected for surgical repair (n=34) had better outcomes than patients treated medically (n=35; 30-day mortality, 47% versus 94%).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions<\/jats:italic>\n                    \u2014Compared with historical control subjects, patients who undergo thrombolysis within 6 hours of infarction onset may have a reduced risk of later VSD. If patients develop this mechanical complication, however, it typically occurs sooner than described in the prethrombolytic era. Despite improvements in medical therapy and percutaneous and surgical techniques, mortality with this complication remains extremely high.\n                  <\/jats:p>","DOI":"10.1161\/01.cir.101.1.27","type":"journal-article","created":{"date-parts":[[2012,6,11]],"date-time":"2012-06-11T20:42:29Z","timestamp":1339447349000},"page":"27-32","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":621,"title":["Risk Factors, Angiographic Patterns, and Outcomes in Patients With Ventricular Septal Defect Complicating Acute Myocardial Infarction"],"prefix":"10.1161","volume":"101","author":[{"given":"Brian S.","family":"Crenshaw","sequence":"first","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (B.S.C., K.S.P., C.B.G., R.M.C.); Rabin Medical Center, Petah-Tiqva, Israel (Y.B.); Emory University, Atlanta, Ga (D.C.M.); Baylor College of Medicine, Houston, Tex (N.S.K.); Hospital Tenon, Paris, France (A.V.); and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher B.","family":"Granger","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (B.S.C., K.S.P., C.B.G., R.M.C.); Rabin Medical Center, Petah-Tiqva, Israel (Y.B.); Emory University, Atlanta, Ga (D.C.M.); Baylor College of Medicine, Houston, Tex (N.S.K.); Hospital Tenon, Paris, France (A.V.); and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yochai","family":"Birnbaum","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (B.S.C., K.S.P., C.B.G., R.M.C.); Rabin Medical Center, Petah-Tiqva, Israel (Y.B.); Emory University, Atlanta, Ga (D.C.M.); Baylor College of Medicine, Houston, Tex (N.S.K.); Hospital Tenon, Paris, France (A.V.); and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen S.","family":"Pieper","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (B.S.C., K.S.P., C.B.G., R.M.C.); Rabin Medical Center, Petah-Tiqva, Israel (Y.B.); Emory University, Atlanta, Ga (D.C.M.); Baylor College of Medicine, Houston, Tex (N.S.K.); Hospital Tenon, Paris, France (A.V.); and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas C.","family":"Morris","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (B.S.C., K.S.P., C.B.G., R.M.C.); Rabin Medical Center, Petah-Tiqva, Israel (Y.B.); Emory University, Atlanta, Ga (D.C.M.); Baylor College of Medicine, Houston, Tex (N.S.K.); Hospital Tenon, Paris, France (A.V.); and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neal S.","family":"Kleiman","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (B.S.C., K.S.P., C.B.G., R.M.C.); Rabin Medical Center, Petah-Tiqva, Israel (Y.B.); Emory University, Atlanta, Ga (D.C.M.); Baylor College of Medicine, Houston, Tex (N.S.K.); Hospital Tenon, Paris, France (A.V.); and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alec","family":"Vahanian","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (B.S.C., K.S.P., C.B.G., R.M.C.); Rabin Medical Center, Petah-Tiqva, Israel (Y.B.); Emory University, Atlanta, Ga (D.C.M.); Baylor College of Medicine, Houston, Tex (N.S.K.); Hospital Tenon, Paris, France (A.V.); and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Califf","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (B.S.C., K.S.P., C.B.G., R.M.C.); Rabin Medical Center, Petah-Tiqva, Israel (Y.B.); Emory University, Atlanta, Ga (D.C.M.); Baylor College of Medicine, Houston, Tex (N.S.K.); Hospital Tenon, Paris, France (A.V.); and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric J.","family":"Topol","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (B.S.C., K.S.P., C.B.G., R.M.C.); Rabin Medical Center, Petah-Tiqva, Israel (Y.B.); Emory University, Atlanta, Ga (D.C.M.); Baylor College of Medicine, Houston, Tex (N.S.K.); Hospital Tenon, Paris, France (A.V.); and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(92)90203-N"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(10)63093-7"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(84)80067-3"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.74.1.3708777"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.49.6.550"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.62.4.268"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(89)90617-0"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.64.3.7020978"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.77.1.3335071"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(95)90309-7"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)33699-2"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)36347-0"},{"key":"e_1_3_2_13_2","unstructured":"Bolooki HB. Emergency cardiac procedures in patients in cardiogenic shock due to complications of coronary artery disease. 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