梗死后室间隔缺损：英国国家注册研究中经皮与外科治疗的比较
Post-infarction ventricular septal defect: percutaneous or surgical management in the UK national registry
梗死后室间隔缺损（PIVSD）是急性心肌梗死的严重并发症，预后差。研究纳入英国16个中心2010至2021年间接受外科或经皮修补的362例患者（共416次操作）。经皮组患者年龄更大，外科组更多合并心源性休克。外科组住院死亡率较低（44.2%对55.0%），但出院后长期死亡率两组无差异（61.1%对53.7%）。心源性休克、经皮路径和冠脉病变血管数是长期死亡率的独立相关因素。结论认为两种修补方式均可行。
为什么推荐给您：大型国家注册研究比较两种策略，规模较大且设计严谨，但非新疗法。
不需要生物学背景，多打比方
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摘要Abstract
AIMS: Post-infarction ventricular septal defect (PIVSD) is a mechanical complication of acute myocardial infarction (AMI) with a poor prognosis. Surgical repair is the mainstay of treatment, although percutaneous closure is increasingly undertaken.
METHODS AND RESUTS: Patients treated with surgical or percutaneous repair of PIVSD (2010-2021) were identified at 16 UK centres. Case note review was undertaken. The primary outcome was long-term mortality. Patient groups were allocated based upon initial management (percutaneous or surgical). Three-hundred sixty-two patients received 416 procedures (131 percutaneous, 231 surgery). 16.1% of percutaneous patients subsequently had surgery. 7.8% of surgical patients subsequently had percutaneous treatment. Times from AMI to treatment were similar [percutaneous 9 (6-14) vs. surgical 9 (4-22) days, P = 0.18]. Surgical patients were more likely to have cardiogenic shock (62.8% vs. 51.9%, P = 0.044). Percutaneous patients were substantially older [72 (64-77) vs. 67 (61-73) years, P < 0.001] and more likely to be discussed in a heart team setting. There was no difference in long-term mortality between patients (61.1% vs. 53.7%, P = 0.17). In-hospital mortality was lower in the surgical group (55.0% vs. 44.2%, P = 0.048) with no difference in mortality after hospital discharge (P = 0.65). Cardiogenic shock [adjusted hazard ratio (aHR) 1.97 (95% confidence interval 1.37-2.84), P < 0.001), percutaneous approach [aHR 1.44 (1.01-2.05), P = 0.042], and number of vessels with coronary artery disease [aHR 1.22 (1.01-1.47), P = 0.043] were independently associated with long-term mortality.
CONCLUSION: Surgical and percutaneous repair are viable options for management of PIVSD. There was no difference in post-discharge long-term mortality between patients, although in-hospital mortality was lower for surgery.