| Background:In recent years,with the widespread popularity of the chest pain centers in China,the timeliness of revascularization in patients with AMI has been significantly improved,which has declined the inhospital mortality remarkably.However,as one of the fatal complications following AMI,the mortality of CR has been still very high,and optimal preventive and therapeutic strategies remain controversial.This study aimed to analyze the characteristics of CR post AMI,and find the relevant clinical risk factors.Moreover,to identify high-risk patients as early as possible for avoiding an inappropriate revascularization therapy and adopting more effective managements to reduce the morbidity and mortality.Methods: Of 2696 STEMI patients in the chest pain center of our institution between January 2015 and December 2019,a total of 29 CR were retrospectively studied.The clinical characteristics of patients with CR following AMI were analyzed,and patients were divided into rupture and control groups,in comparison with clinical relevant factors,firstmedical contact time and the method of revascularization.Independent factors of CR were analyzed using the multivariate logistic regression.Results:1)Of 2696 STEMI patients,29(1.08%)patients had CR including free wall rupture(14 cases)and ventricular septal rupture(15cases).Most of the FWR occurred within 7 days of symptoms(13 cases,92.9%),and all patients with FWR died during hospitalization.The average time from CR to death was 1.09 ± 0.413h;there were 15 cases(51.7%)of VSR,most of them occurred within 48 hours of symptoms(10 cases,66.7%),and the patients with anterior myocardial infarction were susceptible to ventricular septal rupture(11 cases,73.3%).Although the inhospital mortality of VSR was 33.3%,the mortality was up to 86.7% within30-day follow-up.2)The gender of women(55.2% VS 24.1%,P = 0.002),age(71.9 ± 9.432 VS 67.1 ± 11.984 years,P = 0.051),and systolic blood pressure at admission [108(90,131)VS 122(108,140)mmHg,P =0.012] had significant difference.Compared with control group,the patients of CR had more impaired hemodynamic consequences such as higher heart rate(96.17 ± 25.774 VS 80 ± 16.949 beats / min,P =0.051),cardiogenic shock(34.5% VS 3.4%,P <0.001),killip III-IV grade(55.2% VS 9.2%,P <0.001)and lower left ventricular ejection fraction[52(47.75,56)% VS 56(50,59)%,P = 0.027],as well as underwent more treatments for IABP(20.7%VS 2.3%,P = 0.003)and mechanical assisted ventilation(79.3% VS 10.3%,P <0.001).Conversely,PCI(48.3% VS83.9%,P <0.001),?-blockers(44.8% VS 82.8%,P <0.001),and ACEI /ARB(20.7% VS 75.9%,P <0.001)managements were less performed in the rupture group.3)The multivariate logistic regression analysis found that the fast heart rate(OR = 1.037,95% CI: 1.005 ~ 1.070,P = 0.024)and the increased white blood cell count(OR = 1.189,95% CI: 1.006 ~1.404,P = 0.042)were independent risk factors of CR post AMI,while using ?-blockers(OR = 0.145,95% CI: 0.031 ~ 0.691,P = 0.015)and PCI treatment(OR = 0.184,95% CI: 0.046 ~ 0.745,P = 0.018)are protective factors.Conclusion: CR post AMI remains one of the biggest challenges of the daily clinical work in the chest pain center due to its higher mortality;Fast heart rate and increased white blood cell count at admission are independent risk factors for CR post AMI,while using ?-blockers and PCI are protective factors;In addition to paying more attention to the timeliness of revascularization for AMI patients,it should identify patients with high-risk of CR and make definite diagnosis of CR immediately to avoid inappropriate revascularization treatment.The more optimal therapeutic strategies should be employed to reduce the morbidity and mortality of the CR. |
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