| Objective:Cardiac rupture is a serious mechanical complication of acute myocardial infarction.once it occurs,the hemodynamics of the patients can deteriorate rapidly,the general rescue is usually ineffective,the fatality rate is very high and the prognosis is very poor,so how to identify the high-risk patients with cardiac rupture early and prevent the occurrence of cardiac rupture has important clinical significance.Methods:99 patients with cardiac rupture after acute myocardial infarction diagnosed in the first affiliated Hospital of Nanchang University and Jiangxi Provincial people's Hospital from January 2013 to December 2019 were selected as the heart rupture group.228 patients without cardiac rupture after acute myocardial infarction admitted within the same week as the heart rupture group were selected as the control group,and the hospitalization data of the two groups were statistically analyzed.Multivariate Logistic regression analysis was used to explore the risk factors of cardiac rupture after acute myocardial infarction.Results:1?82 cases died in the heart rupture group,with a fatality rate of 82.8%,with an average of 4.9 days from symptom onset to death,including 67 cases of free wall rupture(67.7%),65 cases of death,the case fatality rate was 97%,31 cases of interventricular septum perforation(31.3%),16 cases died,the fatality rate was51.6%,and 1 case of papillary muscle rupture(1%).2?In terms of inducement,most of the patients suffered from emotional agitation,tension,repeated chest tightness,chest pain,malignant arrhythmia,acute left heart failure,toilet and other causes before the occurrence of cardiac rupture.3?The average age,heart rate,percentage of white blood cells,neutrophils,transaminase,blood glucose,creatinine,urea nitrogen,uric acid,time from onset of symptoms to treatment,proportion of acute ST segment elevation myocardial infarction,proportion of malignant arrhythmia and acute left heart failure during hospitalization,proportion of low level of wall motion,proportion of cardiac function grade(Killip grade)above II grade,GRACE ischemia score and CRUSADE bleeding score in the heart rupture group were higher than those in the control group.Hemoglobin,hematocrit,lymphocyte percentage,albumin,total protein,serum calcium,low density lipoprotein,left ventricular ejection fraction,The proportion of coronary heart disease,proportion of emergency PCI,The use of bivalirudin,GPIIb/IIIa receptor antagonist(tirofiban),ACEI/ARB drugs(ACEI as angiotensin converting enzyme inhibitor,ARB as angiotensin receptor blocker),statins and?receptor blockers were significantly lower than those in the control group.4?Multivariate logistic regression analysis showed that the concentration of serum calcium was lower than that of 2.2mmol/L(OR=6.982,95%CI:2.766,17.563),the number of white blood cells was higher than that of 12x10~9/L(OR=3.046,95%CI:1.214,7.639),the level of glutamic pyruvic transaminase was higher than that of 80mmol/L(0R=5.074,95%CI:1.733,14.861),and emergency PCI was not performed in early stage(OR=2.899,95%CI:1.192,7.053),acute ST segment elevation myocardial infarction(OR=4.057,95%C1:1.373,11.986),high level of creatinine(0R=3.046,95%CI:1.155,8.035),and systolic hypotension(OR=2.932,95%CI:1.226,7.012)were independent risk factors for cardiac rupture after acute myocardial infarction,while age<60 years old(OR=0.294,95%CI:0.096,0.896)was a protective factor.Conclusion:The concentration of serum calcium was lower than that of 2.2mmol/L,the number of white blood cells was higher than that of 12x10~9/L,the level of glutamic pyruvic transaminase was higher than that of 80mmol/L,and emergency PCI was not performed in early stage,acute ST segment elevation myocardial infarction,high level of creatinine,and systolic hypotension were independent risk factors for cardiac rupture after acute myocardial infarction,while age<60 years old was a protective factor. |
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