| Objective: To investigate the incidence and risk factors of cardiac rupture (CR) in patients with ST-elevation myocardial infarction (STEMI), and to identify patients with high risk.Methods: There were total3475patients, of which2638cases diagnosed STEMI in coronary care unit (CCU) of TEDA International Cardiovascular Hospital from October2005to December2013were enrolled. CR was confirmed in53patients with STEMI. Clinical data of those were retrospectively reviewed. They were divided into CR group and no-CR group. Summarize and analyze the correlation factors of CR. The logistic regression model was used to explore the risk factors of patients with STEMI complicated by CR.Results:1. There were total2638patients with STEMI hospitalized in the CCU, of which53cases diagnosed cardiac rupture, including32patients with free wall rupture (FWR),18patients with ventricular septal perforation (VSP) and3patients with papillary muscle rupture (PMR).18cases occurred cardiac rupture in24hours after infarction onset,29cases occurred between2to7days after infarction onset and6patients occurred after one week. The mean age of the53patients with cardiac rupture was74.2±8.3year, including21male with71.5±9.6year and32female with76.0±7.2year. In the CR group,50patients were primary STEMI while3cases had history of myocardial infarction (MI).2. Patients with CR were older than those without CR [(74.0±8.4) vs.(69.0±8.0) years old, P＜0.001]. Compared with the cases without rupture, the proportion of female gender was higher than male gender in the CR group (P＜0.001). The body mass index (BMI) of the patients with CR was lower than that of cases without CR [23.44(22.29,24.84) vs.25.59(23.14,27.24) kg/m2, P＜0.001]. There were no statistical differences in hypertensive disease history, diabetes mellitus, hyperlipidemia, apoplexy history, smoking history and myocardial infarction (all P>0.05).3. In the CR group,34cases were anterior STEMI, accounting for64.1%(34/53), including22cases with FWR [64.7%(22/34)],12cases with VSP [35.3%(12/34)],18cases were inferior STEMI, accounting for34.0%(18/53), including9cases with FWR [50.0%(9/18)],6cases with VSP [33.3%(6/18)] and3cases with PMR [16.7%(3/18)] and1case with FWR was lateral, posterior wall STEMI, accounting for1.9%(1/53).4. According to the results of coronary angiography (CAG) of the patients, there were no statistical differences in the branch numbers of the pathological blood vessel (P>0.05).5. The clinical data:①Compared with the cases without CR, hospital admission delayed longer in the CR group, but the difference had no statistical significance(P>0.05).②There were no statistical significances in systolic pressure, diastolic pressure and heart rate (all P>0.05).③The proportion of patients with post infarction angina in the CR group was higher than that in the no-CR group (66.0%vs.5.2%, P＜0.05).④The incidence of arrhythmias of two groups had no statistical significances (P>0.05).⑤There were no statistical significances in cTnI maximum, level of hemoglobin at hospital admission and granular leukocyte (all P>0.05).⑥In the CR group, the white blood cell count was higher than that in the no-CR group [(12.9±3.7) vs.(11.3±3.4)*109/L, P＜0.001].⑦The level of serum creatinine (Scr) at hospital admission was higher in the CR group than that of in the no-CR group [71.0(57.0,96.5) vs.66.0(56.3,73.0) umol/L, P＜0.001].⑧There were no statistical significances in the B-type natriuretic peptide (BNP) at hospital admission and the index of echocardiogram [left ventricular ejection fraction (LVEF), left ventricular diastolic diameter (LVDd)](all P>0.05).⑨The proportion of patients with left ventricular aneurysm (LVA) was higher in CR group than that in the no-CR group (49.1%vs.9.0%, P＜0.05).6. There was no statistical significances in heart function classification (Killip classification)(P>0.05).7. Compared with the cases in the no-CR group, the proportion of patients with emergency thrombolysis was higher in the CR group (13.2%vs.4.7%), the proportion of patients treated with emergency percutaneous coronary intervention (PCI) in the CR group was lower than that in the no-CR group (30.2%vs.42.5%), the proportion of patients without early reperfusion was higher in the CR group than that in the no-CR group (56.7%vs.52.8%), and there had statistical significance in the early reperfusion means between the two groups (P<0.05).8. There had no significant differences in bigeminy, trigeminy and quadruple-antithrombotic between patients with or without CR (P>0.05). There were no statistical significances in use of nitrate, ACEI or ARB and statins (P>0.05). Utilization of beta blocker was lower in the CR group than that in the no-CR group (50.9%vs.84.4%, P<0.05). Utilization of nonsteroidal antiinflammatory drugs (NSAIDs) was higher in the CR group than that in the no-CR group (9.4%vs.2.8%, P<0.05).9. Multi-factor regression analysis was used to determine the influence factors of STEMI complicated by CR. Multi-factor regression analysis showed that WBC count (OR=1.179,95%CI:1.051-1.323), female gender (OR=0.251,95%CI:0.107～0.587), post infarction angina (OR=15.540,95%CI:5.411～44.634), LVA (OR=6.250,95%CI:2.531～15.432), lower BMI (OR=0.667,95%CI:0.460～0.967) and higher level of Scr (OR=1.717,95%CI:1.173～2.513) were risk factors for CR after STEMI.10. According to the CRUSADE bleeding risk scoring, all patients were scored. The proportion of the patients with high risk in hemorrhage was higher in CR group than that in no-CR group (81.1%vs.50.5%, P＜0.001).Conclusion:1. It is uncommom that the patients with AMI occur CR [1.5%(53/3475)], of which more are FWR [0.9%(32/3475)], and the CR is more likely happened to the female, older and anterior STEMI.2. It is demonstrated that WBC count, female gengder, post infarction angina, left ventricular aneurysm (LVA), lower BMI and higher level of Scr are the risk factors of cardiac ruputure in patients with STEMI.3. Risk of CR after STEMI is related to the risk of hemorrage. |
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