Risk Factors And Prognosis Of Acute Myocardial Infarction Complicated With Cardiac Rupture

Objective:To analyze the clinical characteristics,risk factors and prognosis of acute myocardial infarction(AMI)complicated with cardiac rupture,and to explore the clinical prevention and treatment measures.Methods:We retrospectively reviewed 1936 patients with AMI from January 2014 to January 2020 in our hospital.Among them,26 patients with cardiac rupture were chosen as the cardiac rupture group.According to the 1:5 matching principle,130 AMI patients who were admitted the same time but did not have cardiac rupture were chosen as the control group.The general data,examination data,changes of condition,coronary angiography and treatment plan of the selected patients were recorded,and the prognosis of the patients with cardiac rupture was analyzed.The risk factors of AMI complicated with cardiac rupture were analyzed by logistic regression model.Results:1.The incidence rate of cardiac rupture was 1.34%,9 males and 17 females.All patients with cardiac rupture were ST segment elevation myocardial infarction,16 of which were free wall ruptured(61.53%),9 of which were ventricular septal ruptured(36.41%),and 1 of which was papillary muscles rupture(3.84%),2.In single factor analysis,there was no significant difference between the two groups in terms of admission systolic pressure,diastolic pressure,diabetes mellitus,hypertension,left ventricular ejection fraction,left ventricular end diastolic diameter,random blood glucose,glycosylated hemoglobin,platelet count,TG,TC,HDL-C,LDL-C,creatinine and blood sodium(P>0.05).The age,female proportion,admission heart rate,troponin,NT-proBNP,leucocyte count,neutrophil count and urea in the heart rupture group were significantly higher than those in the control group(P<0.05).The emergency PCI,hemoglobin,RBC count,use ofβ-blocker and ACEI/ARB were significantly lower than those in the control group(P<0.05).3.Multivariate logistic regression analysis showed:advanced age(OR=1.094,95%CI:1.021～1.173),lower hemoglobin(OR=0.925,95%CI:0.888～0.963),higher neutrophil count(OR=1.179,95%CI:1.030-1.337)were risk factors of cardiac rupture after acute myocardial infarction.Conclusions:1.Before the occurrence of cardiac rupture,there were some abnormal activities or inducements,such as forced defecation,emotional excitement,forced cough,etc.There were two peaks in the time of cardiac rupture.The first peak occurred within one day after AMI,and the second peak occurred one week after AMI.2.Advanced age,lower hemoglobin and higher neutrophil count were the risk factors of cardiac rupture in patients with AMI.Early reperfusion,ACEI/ARB drugs and β-blocker were the important measures to prevent cardiac rupture after AMI.3.In patients with AMI whose reperfusion time was delayed and whose circumflex artery is confirmed by coronary angiography as an infarct related artery,we should pay attention to the occurrence of cardiac rupture.