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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Risk factors and predictive model for mortality in acute myocardial infarction with ventricular septal rupture at high altitudes
Li-Hong Zhang, Zhi-Fu Cen, Qian Qiao, Xue-Rui Ye, Lu Cheng, Gui-Qin Liu, Yi Liu, Xing-Qiang Zhang, Xian-Feng Pan, Hao-Ling Zhang, Jing-Jing Zhang
Li-Hong Zhang, Zhi-Fu Cen, Qian Qiao, Xue-Rui Ye, Lu Cheng, Gui-Qin Liu, Jing-Jing Zhang, Department of Cardiovascular Medicine, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Kunming 650000, Yunnan Province, China
Li-Hong Zhang, Zhi-Fu Cen, Qian Qiao, Xue-Rui Ye, Lu Cheng, Gui-Qin Liu, Jing-Jing Zhang, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming 650000, Yunnan Province, China
Yi Liu, Department of Intensive Care Unit, The Second Affiliated Hospital of Kunming Medical University, Kunming 650000, Yunnan Province, China
Xing-Qiang Zhang, Department of Pharmacy, The Second Affiliated Hospital of Kunming Medical University, Kunming 650000, Yunnan Province, China
Xian-Feng Pan, Department of Emergency Medicine, Kunming Medical University, Kunming 650000, Yunnan Province, China
Hao-Ling Zhang, Department of Biomedical Science, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Pinang 13200, Malaysia
Co-corresponding authors: Hao-Ling Zhang and Jing-Jing Zhang.
Author contributions: Zhang LH and Zhang JJ conceptualized and designed the research; Ye XR, Cheng L, and Liu GQ screened the patients and acquired the clinical data; Cen ZF and Qiao Q collected the blood specimens and performed the laboratory analysis; Cen ZF, Liu Y, and Zhang XQ performed data analysis; Zhang LH, Pan XF, Zhang HL, and Zhang JJ wrote the paper. All the authors have read and approved the final manuscript. Zhang LH proposed, designed, and conducted the study, performed data analysis, and prepared the first draft of the manuscript. He has made crucial and indispensable contributions towards the completion of the project and thus qualified as the first author of the paper. Both Zhang JJ and Zhang HL have played important and indispensable roles in the experimental design, data interpretation, and manuscript preparation as co-corresponding authors. Zhang JJ conceptualized, designed, and supervised the whole process of the project. She searched the literature, and revised and submitted the early version of the manuscript. Zhang HL was instrumental and responsible for re-interpretation, figure plotting, comprehensive literature search, preparation and submission of the current version of the manuscript. This collaboration between Zhang JJ and Zhang HL is crucial for the publication of this manuscript.
Supported by Science and Technology Department of Yunnan Province - Kunming Medical University, Kunming Medical Joint Special Project - Surface Project, No. 202401AY070001-164; Yunnan Provincial Department of Science and Technology Science and Technology Plan Project—Major Science and Technology Special Projects, No. 202405AJ310003; Yunnan Provincial Department of Science and Technology Science and Technology Plan Project - Key Research and Development Program, No. 202103AC100004; and Yunnan Province Science and Technology Department Key Research and Development Plan, No. 202103AC100002.
Institutional review board statement: The research was approved by the Ethics Committee of Fuwai Yunnan Hospital, Chinese Academy of Medical Science (Approval No. 2023-026-01).
Informed consent statement: All patients in this study provided written informed consent.
Conflict-of-interest statement: There is no conflict of interest related to this study.
Data sharing statement: The original data of this study can be obtained from the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jing-Jing Zhang, Assistant Professor, Department of Cardiovascular Medicine, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, No. 528 Shahe North Road, Kunming 650000, Yunnan Province, China.
zhangjingjing1@kmmu.edu.cn
Received: April 29, 2025
Revised: May 29, 2025
Accepted: June 30, 2025
Published online: July 26, 2025
Processing time: 85 Days and 5.9 Hours
BACKGROUND
Acute myocardial infarction (AMI) combined with ventricular septal perforation (VSR) is still a highly fatal condition in the era of reperfusion therapy. The incidence rate has decreased to 0.2%-0.4% due to the popularization of percutaneous coronary intervention. However, the risk is significantly increased for those who fail to undergo revascularization in time, and the mortality rate remains high. The current core contradiction in clinical practice lies in the selection of surgical timing, and the disparity in medical resources significantly affects prognosis. There is an urgent need to optimize the identification of high-risk populations and individualized treatment strategies.
AIM
To investigate the clinical features, determine the prognostic factors, and develop a predictive model for 30-day mortality in patients with acute myocardial infarction complicated by ventricular septal rupture (AMI-VSR) residing in high-altitude regions.
METHODS
This study retrospectively analyzed 48 AMI-VSR patients admitted to a Yunnan hospital from 2017 to 2024, with the establishment of survival (n = 30) and mortality (n = 18) groups based on patients’ survival status. Risk factors were identified by univariate and multivariate logistic regression analyses. A nomogram model was developed using R software and validated via receiver operating characteristic (ROC) analysis and calibration curves.
RESULTS
Age, uric acid (UA), interleukin-6 (IL-6), and low hemoglobin (Hb) were independent risk factors for 30-day mortality (odds ratios: 1.147, 1.006, 1.034, and 0.941, respectively; P < 0.05). The nomogram demonstrated excellent discrimination (area under the ROC curve = 0.939) and calibration (Hosmer-Lemeshow χ² = 2.268, P = 0.971). In addition, patients’ poor outcomes could be synergistically predicted by IL-6 and UA, advanced age, and reduced Hb.
CONCLUSION
This study highlights age, UA, IL-6, and Hb as critical predictors of mortality in AMI-VSR patients at high altitudes. The validated nomogram provides a practical tool for early risk stratification and tailored interventions, addressing gaps in managing this high-risk population in resource-limited settings.
Core Tip: This study identifies key clinical factors—age, uric acid, interleukin-6, and hemoglobin—as significant predictors of 30-day mortality in acute myocardial infarction complicated by ventricular septal rupture at high altitudes. A nomogram model developed from these risk factors demonstrates excellent predictive power, offering a valuable tool for early mortality risk assessment and intervention in high-risk populations.
