Analysis Of Risk Factors And Coronary Angiography For Cardiac Rupture After Acute Myocardial Infarction

Objective:To analyze the clinical characteristics,risk factors and coronary angiography of cardiac rupture(CR)in patients after acute myocardial infarction(AMI)and to explore the prevention and treatment strategy in clinical practice.Methods:There were total 44 patients(CR group)diagnosed AMI complicated with CR at the Xiamen Cardiovascular Hospital Xiamen University from January 2013 to December 2017.176 patients diagnosed AMI without CR of the same year and the same month in hospital were chosen randomly as a control group.We retrospectively reviewed the clinical characteristics,test results,infarction location,coronary angiography and therapeutic measures.Statistical analysis was performed to summarize the risk factors of cardiac rupture.Results:1.There were 4658 patients with acute myocardial infarction in hospital from January 2013 to December 2017,of which 44 cases(0.94%)diagnosed cardiac rupture,including 19 cases(43.2%)diagnosed ventricular septal rupture,14 cases(31.8%)with free wall rupture and 11 cases(25%)with papillary muscle rupture.There were 34 patients diagnosed acute ST-segment elevation myocardial infarction(STEMI)complicated with CR,and 10 patients diagnosed acute non-ST-segment elevation myocardial infarction(NSTEMI)complicated with CR.The mortality rate of CR was 63.6%(28 cases),including 12 cases(63.2%)with ventricular septal rupture,14 cases(100%)with free wall rupture and 2 cases(18.2%)with papillary muscle rupture.The average time form chest pain to CR was(6.29±5.97)days.2.There were statistical differences in clinical characteristics between CR group and control group(p<0.05).The patients diagnosed AMI complicated with cardiac rupture were older than those without cardiac rupture(p<0.05).The proportion of female gender in CR group was higher than that of control group(p<0.05).Compared with the cases in control group,the average heart rate was rapider in CR group.Cardiac Troponin T(cTnT),NT-pro brain natriuretic peptide(NT-proBNP),white blood cells counts were all significantly higher than the control group(p<0.05).The average level of creatinine in CR group was higher than the control group(p<0.05).The average systolic pressure and diastolic pressure at admission were all significantly lower than the control group(p<0.05).In the CR group,left ventricular ejection fraction(LVEF)was lower than that of the control group(p<0.05).The advanced age,female,rapid heart rate were found as the risk factors of the occurrence of cardiac rupture after acute myocardial infarction.3.There were significant differences in medication between patients with or without cardiac rupture.The administration rates of dual antiplatelet therapy(DAPT),statins and anticoagulant of CR group were lower than the control group(p<0.05).In addition,compared with the cases in control group,the use of beta-blocker and angiotensin converting enzyme inhibitors/angiotensin receptor blockers(ACEIS/ARBS)in CR group were lower.And the difference had statistical significance(p<0.05).4.13 cases(29.5%)of CR patients underwent percutaneous coronary intervention(PCI)and 6 died(46.2%).The most common location of myocardial infarction was anterior wall(22 cases,64.7%)and the single myocardial wall(24 cases,70.6%).According to the results of coronary angiography of the patients with cardiac rupture,the most common culprit vessels were the left anterior descending branch(40%)and the left circumflex branch(40%).Conclusion:The incidence of CR after AMI was 0.94%.AMI complicated with CR was uncommon.However,patients with CR after AMI have a high mortality rate.It was common in-hospital death factors for patients with AMI.Advanced age,female,rapid heart rate were found as the risk factors of the occurrence of cardiac rupture after AMI.In the era of reperfusion therapy,the culprit vessel not only limited to left anterior descending branch.It is necessary to strengthen the study for the clinical features of AMI with CR,in order to identify high-risk patients early,to strengthen prevention and treatment strategy in clinical practice,and to reduce morbidity and mortality of cardiac rupture after AMI.