Clinical Characteristics In 112 Patients Of Acute ST-Elevation Myocardial Infarction Complicated With Cardiac Rupture

ObjectiveTo analyze the clinical characteristics and risk factors of cardiac rupture(CR)in patients with acute ST-elevation myocardial infarction(STEMI)and to explore the prevention and treatment strategy in clinical practice.MethodA total of 112 consecutive patients who were diagnosed STEMI complicated with CR in the Department of Cardiovascular Diseases at the First Hospital of Jilin University from January 2014 to December 2016 were selected as the subjects of this study,defined as CR group,and the STEMI patients without CR of the same year in hospital were selected randomly as the non-CR group according to the ratio of 1:3,matching conditions were the same sex and age more or less than one year.Clinical information was compared between two groups and the relevant risk factors for predicting CR were studied by logistic regression analysis.Result1、In the 6007 patients diagnosed STEMI from January 2014 to December 2016,CR occurred in 112 patients.The incidence of STEMI complicated with CR was 1.9%,including 82 patients with free wall rupture(FWR)(71.9%),31 patients with ventricular septal rupture(VSR)(27.2%),1 patients with papillary muscle rupture(PMR)(0.9%).Two patients complicated with VSR finally occured FWR.The average age of all STEMI patients complicated with CR was(68.9±9.74)years,including 52 males and 60 females.2 、 There were some predisposing factors inducing the occurrence of the post-infarction cardiac rupture,such as forced cacation,severe nausea and so on.3、STEMI patients often occured CR within one week,in this study 91% of CR occurred within one week after STEMI.OF all the patients developing CR,61 patients(54%)occurred CR in 24 hours after STEMI and 25 patients(22%)developed CR between 3 to 5 days after STEMI.4、Of the 112 CR patients,63 cases were anterior STEMI,including 52 cases with FWR(81.2%),12 cases with VSR(18.8%),one patients complicated with VSR finally occurred FWR.35 patients were inferior STEMI,including 21 patients with FWR(60%),13 patients with VSR(37.1%)and 1 patient with PMR(2.9%).9 cases were anterior STEMI complicated with inferior STEMI,including 4 cases with FWR(40%)and 6 cases with VSR(60%),one patients complicated with VSR finally occur FWR.5 patients were lateral STEMI,all of these 5 cases were FWR.5、The single factor analysis:(1)the age and proportion of female in two groups were almost same.The proportion of diabetes mellitus,hypertention and stroke history in the CR group was higher than that in the non-CR group(P>0.05).The proportion of AMI history and previous smoking was lower than that in the control group(P>0.05).(2)In CR group,the levels of white blood cell count,neutrophil count,percentage of neutrophils,monocyte count,random blood glucose,prothrombin time,aspartate aminotransferase,alanine aminotransferase,γ-glutamyl transpeptidase,total bilirubin,direct bilirubin and fasting blood glucose were higher than the control group(P<0.05),while the levels of the number of eosinophils,percentage of lymphocytes and plasma sodium were lower compared with the control group(P<0.05).(3)The systolic blood pressure of CR group was lower than that of the control group(P <0.05).The heart rate,peak of troponin I,D-dimer,brain natriuretic peptide(BNP),ratio of anterior myocardial infarction,the proportion of killip III to IV grade and repeated chest pain after myocardial infarction were higher than that of the control group(P<0.05).(4)Coronary angiography results suggested that non-CR group had better collateral circulation(P<0.05).(5)As to the treatment,non-cardiac rupture group adopted recommended drugs and primary PCI treatment frequently(P<0.05).6、Conditional logistic regression analysis was used to determine the risk factors of STEMI complicated with CR.Multi-factor regression analysis showed that lower systolic blood pressure(OR=0.984,95%CI:0.975~0.994),higher heart rate(OR= 1.021,95%CI: 1.007~1.037),repeated chest pain after myocardial infarction(OR= 11.947,95%CI: 3.639 ~ 39.218),increased white blood count(WBC)(OR= 1.105,95%CI:1.03 ~ 1.185),the higher percentage of neutrophils(OR= 17.089,95%CI:1.216 ~ 240.221)were independent risk factors for patients with STEMI.Conclusion1.The incidence of STEMI complicated with CR was 1.9%,CR was uncommon,and most of CR were FWR.2.CR always occured within one week after STEMI,including two peak hours,respectively in 24 hours and 3~5 days after STEMI.3.Lower systolic blood pressure,higher heart rate,repeated chest pain after myocardial infarction,increased WBC count,higher percentage of neutrophils were significant risk factors for STEMI complicated with CR.