| Objective:Cardiac rupture is a serious mechanical complication of acute myocardial infarction.Once it occurs,it is extremely difficult to treat and the mortality is extremely high.The purpose of this study is to retrospectively analyze the previous clinical data,analyze the risk factors and characteristics of cardiac rupture in patients with acute ST segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI),and provide an early warning mechanism for identifying high-risk patients with cardiac rupture as early as possible.Methods:The medical records of patients with STEMI diagnosed in Cangzhou Central Hospital and Tianjin Thoracic Hospital from January 2013 to August 2019 were analyzed retrospectively.A total of 183 patients with cardiac rupture were taken as the experimental group: Cardiac Rupture Group.According to the proportion of 1:2,366 patients without cardiac rupture admitted at the same time selected as the Control Group.Among the 183 patients with cardiac rupture,45 patients who had cardiac rupture after direct PCI were taken as a subgroup of Cardiac Rupture Group: PCI Rupture Group.According to the proportion of 1:2,90 patients without cardiac rupture who underwent direct PCI and admitted at the same time were randomly selected as PCI Control Group.The general data,previous medical history,admission timeline,laboratory results,admission symptoms,treatment,events and vital signs during hospitalization,and operation-related conditions were observed.Logistic regression was used to analyze the risk factors of cardiac rupture after PCI.Results:1.The incidence of cardiac rupture after STEMI was 1.51%;the incidence of cardiac rupture in patients with direct PCI was 0.62%,the incidence of cardiac rupture in patients without direct PCI was 2.81%;2.The age and female ratio of Cardiac Rupture Group and PCI Rupture Group were higher than those of Control Group and PCI Control Group(P<0.001).The incidence of ischemic stroke in PCI Rupture Group was higher than that in PCI Control Group(P=0.001);3.The total time of chest pain in the Cardiac Rupture Group was longer than that in the Control Group(P<0.001),and the difference was statistically significant.The chest pain-admission time,total chest pain time and chest pain-balloon dilatation time in the PCI Rupture Group were longer than those in the PCI Control Group(P<0.05);4.The white blood cell count,neutrophil percentage and absolute neutrophil count in the Cardiac Rupture Group and PCI Rupture Group were higher than those in the Control Group and PCI Control Group(P<0.05),while the red blood cell count,hemoglobin and hematocrit were lower than those in the Control Group and PCI Control Group(P<0.05).CK,CK-MB and NT-pro BNP in Cardiac Rupture Group and PCI Rupture Group were higher than those in Control Group and PCI Control Group(P<0.05).The percentage of lymphocytes in the Cardiac Rupture Group was lower than that in the Control Group,and the difference was statistically significant(P < 0.05).The levels of creatinine and urea nitrogen in the Cardiac Rupture Group were higher than those in the Control Group(P<0.05),and the blood urea nitrogen level in the PCI Rupture Group was higher than that in the PCI Control Group(P<0.05);5.In the vital signs of admission,systolic blood pressure,diastolic blood pressure and heart rate in the Cardiac Rupture Group were significantly higher than those in the Control Group(P<0.001).3.8% of patients in the Cardiac Rupture Group developed cardiogenic shock on admission,which was higher than that in the Control Group(1.1%),and the difference was statistically significant(P=0.048).The patients in the Cardiac Rupture Group complained more gastrointestinal symptoms on admission than those in the Control Group(P=0.011).In the Cardiac Rupture Group,there were more patients with limited anterior wall and high lateral wall myocardial infarction than those in the Control Group,and the difference was statistically significant(P<0.001).The proportion of high lateral wall myocardial infarction in PCI Rupture Group was higher than that in PCI Control Group(P=0.004);6.The proportion of low molecular weight heparin,double antiplatelet treatment,β-blocker and ACEI/ARB in the Cardiac Rupture Group was lower than that in the Control Group(P<0.001).There were more patients using diuretics(P<0.001)and positive inotropic drugs(P=0.001)than those in the Control Group,and the difference was statistically significant.The proportion of ACEI/ARB drugs used in the PCI Rupture Group was lower than that in the PCI Control Group(P=0.002),while the proportion of diuretics(P= 0.001)and positive inotropic drugs(P=0.035)in the PCI Control Group was higher than that in the PCI Control Group;7.The incidence of ischemia,chest pain,acute heart failure and infection in the Cardiac Rupture Group was significantly higher than that in the Control Group.The incidence of ischemia(P=0.032),chest pain(P=0.008)and acute heart failure(P<0.001)in PCI Rupture Group was higher than that in PCI Control Group;8.The proportion of single vessel lesion in PCI Rupture Group was higher than that in PCI Control Group(P<0.01),and the difference was statistically significant.The preoperative TIMI blood flow grade and postoperative TIMI blood flow grade in the PCI Rupture Group were lower than those in the PCI Control Group(P<0.05);9.Logistic multivariate regression analysis showed that age(OR=1.175,95%CI:1.094-1.261,P<0.001),total chest pain time(OR=1.318,95%CI:1.053-1.650,P=0.016),white blood cell count(OR=1.180,95%CI:1.019-1.367,P=0.027),high lateral wall myocardial infarction(OR=5.496,95%CI:1.303-23.186,P=0.020)and single vessel disease(OR=8.778,.95%CI: 2.625-29.354,P<0.001)and ischemic events during hospitalization(OR=8.473,95%CI:1.595-45.000,P=0.012)were independent risk factors of cardiac rupture after direct PCI in patients with acute ST segment elevation myocardial infarction.Conclusion:Age,total chest pain time,white blood cell count,high lateral wall myocardial infarction,single vessel disease and ischemic events during hospitalization were independent risk factors of cardiac rupture after direct PCI in STEMI.For patients with these risk factors,although PCI is successful,family communication and rescue preparations should be made. |
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