| Objective:Cardiac rupture is the most serious complication of acute myocardial infarction,which usually occurs suddenly and is missed due to the inability to perform cardiac ultrasound in a timely manner,and different rupture sites have different manifestations and are difficult to carry out effective treatment.cardiac rupture is also the most dangerous cause of death after cardiogenic shock and has a high mortality rate.Therefore,early identification of patients at high risk of cardiac rupture,establishment of a cardiac rupture risk prediction model,implementation of active interventions,and formulation of correct treatment decisions can help prevent and reduce the occurrence of cardiac rupture.Methods:A total of 5490 patients in the acute myocardial infarction database of the First Affiliated Hospital of Nanchang University and Jiangxi Provincial People’s Hospital were selected from January 2013 to September 2020,of which 126 patients diagnosed with cardiac rupture were included in the cardiac rupture group,and 339 patients admitted within the same 1 week as the cardiac rupture group were selected as the non-cardiac rupture group from the remaining 5364 patients without cardiac rupture;465 acute myocardial infarction patients were finally included,with 314 cases as the modeling group(86 cases in the cardiac rupture group and 228 cases in the non-cardiac rupture group)and 151 cases as the validation group(40 cases in the cardiac rupture group and 111 cases in the non-cardiac rupture group).Univariate analysis was performed on the risk factors of cardiac rupture,and the indicators with P<0.05in the results were screened out and introduced into the multi-factor logistic regression analysis to obtain independent risk factors for cardiac rupture,and a prediction model for the risk of cardiac rupture was established based on the weighted assignment of each risk factor,and the value of the model was tested in the validation group by the area under the subject work characteristic curve and the Hosmer-Lemeshow test to detect the discrimination and calibration of the model,and the value of the model was tested in the validation group.Results:1.In the modeling group,there were 65 cases(75.6%)of free wall rupture,64deaths,with a morbidity and mortality rate of 98.5%;20 cases(23.3%)of ventrcular Septum Rupture,7 deaths,with a morbidity and mortality rate of 35%;1 case(1.1%)of papillary muscle rupture,and no death.In the validation group,there were 22 cases(55%)of free wall rupture,20 cases of death,with a morbidity and mortality rate of90.9%;16 cases(40%)of ventrcular Septum Rupture,11 cases of death,with a morbidity and mortality rate of 68.75%;2 cases(5%)of papillary muscle rupture,and no death.2.In the modeling group,proportion of female patients,mean age,heart rate,proportion of ST-segment elevation myocardial infarction,proportion of acute heart failure,chest pain and chest tightness and malignant arrhythmias during hospitalization,proportion of cardiac function Killip class II or higher,proportion of CRUSADE bleeding risk score and GRACE ischemic risk score at high risk,proportion of ST-segment persistent depression or elevation,white blood cell count,neutrophil granulocyte percentage,neutrophil percentage/lymphocyte percentage,D-dimer,neutrophil percentage/albumin,aspartate transaminase,alanine aminotransferase,gamma glutamyl transferase,creatinine,urea nitrogen,uric acid,glucose,creatine kinase,creatine kinase-MB,brain natriuretic peptide,lactate dehydrogenase,troponin I,percentage of ventricular wall motion hypoplasia,and thrombolytic therapy were higher than those in the unruptured group;Mean systolic and diastolic blood pressure,past history such as history of hyperlipidemia,history of coronary artery disease,history of percutaneous transluminal coronary intervention,history of smoking,recent angina pectoris,red blood cell count,hemoglobin,red blood cell pressure,lymphocyte percentage,absolute lymphocyte value,basophil and eosinophil percentage,total protein,albumin,calcium ion,total cholesterol,percutaneous transluminal coronary intervention,left ventricular ejection fraction,emergency percutaneous transluminal coronary intervention,low molecular heparin,angiotensin converting enzyme inhibitors/angiotensin receptor blocker drugs,beta-blocker drugs use were lower than those in the unruptured group;the difference was statistically significant(P<0.05).3.Multi-factor logistic regression analysis of the modelling group showed that age≥63 years(OR=2.446,95%CI:1.017,5.881,P=0.046),female(OR=2.614,95%CI:1.155,5.917,P=0.021),systolic blood pressure≤120 mm Hg on admission(OR=2.569,95%CI:1.121,5.887,P=0.026),heart rate≥100 beats/min on admission(OR=2.532,95%CI:1.055,6.073,P=0.037),NPAR≥2.2(OR=3.328,95%CI:1.463,7.57,P=0.004),serum creatinine≥106 umol/L(OR=2.744,95%CI:1.178,6.392,P=0.019),and serum calcium ion concentration≤2.2 mmol/L(OR=3.059,95%CI:1.369,6.835,P=0.006)were risk factors for cardiac rupture after acute myocardial infarction;while emergency PCI was performed(OR=0.442,95%CI:0.146,P=0.006).%CI:0.146,0.73,P=0.047),and oral beta-blockers(OR=0.268,95%CI:0.118,0.607,P=0.002)were the protective factors.4.Validation group of rupture in patients with mean age,heart rate,ST-elevation myocardial infarction rate,hospital stay,acute heart failure,chest pain,chest tightness,and malignant arrhythmia during hospitalization,the high-risk proportion of Killip grade II or higher in cardiac function,the high-risk proportion of CRUSADE bleeding risk score and GRACE ischemic risk score,ST segment continuous depression or elevation ratio,cardiac color Doppler ultrasound prompts the proportion of low wall motion,white blood cell count,neutrophil percentage,neutrophil percentage/lymphocyte percentage,D-dimer,neutrophil percentage/Albumin,aspartate transaminase,alanine aminotransferase,gamma glutamyl transferase,creatinine,urea nitrogen,uric acid,creatine kinase,creatine kinase-MB,brain natriuretic peptide,lactate dehydrogenase,alkaline phosphatase,troponin I,potassium ions are all higher than Unruptured group;mean systolic blood pressure,recent angina pectoris,red blood cell count,hemoglobin,hematocrit,percentage of lymphocytes,percentage of basophils and eosinophils,total protein,albumin,calcium,sodium,chloride,left ventricular ejection fraction,The proportions of using angiotensin converting enzyme inhibitors/angiotensin receptor,beta-blocker drugs and tirofiban drugs were lower than those of the unruptured group;the difference was statistically significant(P<0.05).5.Nine risk factors were derived from multi-factorial logistic regression analysis,and scores were assigned according to theirβvalues:age≥63 years old,female,systolic blood pressure≤120 mm Hg on admission,heart rate≥100 beats/min on admission,NPAR≥2.2,serum creatinine≥106 umol/L,serum calcium ion concentration≤2.2 mmol/L,no emergency percutaneous transluminal coronary intervention,and no oral beta-blocker were assigned 1 point respectively.Patients were classified into two groups:low risk group(0-4 points)and high risk group(≥4points)by selecting the score threshold according to the score maximum Jorden index(4.5).6.The modeling group had a sensitivity of 84.4%and a specificity of 89.8%for the risk of rupture stratification model,with an AUC(0.906,95%CI:0.865,0.948),Hosmer-Lemeshow test(X~2=14.297,P=0.074);the validation group had a sensitivity of 73.3%and a specificity of 69.6%for the model,with an AUC(0.785,95%CI:0.696,0.875),Hosmer-Lemeshow test(X~2=1.7,P=0.989).Conclusions:1.Elderly age,female,low systolic blood pressure on admission,rapid heart rate on admission,elevated neutrophil percentage-albumin ratio,elevated serum creatinine,and decreased serum calcium ion concentration are risk factors for cardiac rupture after acute myocardial infarction,for which emergency percutaneous transluminal coronary intervention and oral beta-blockers are protective factors.2.On the basis of these nine risk factors,a risk prediction model for cardiac rupture after acute myocardial infarction was established,which provides a certain reference basis for medical workers to identify high-risk cardiac rupture patients early,implement interventions actively,and make correct treatment decisions. |
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