| Purpose: The related risk factors and traditional Chinese medicine(TCM)constitution for cardiac rupture complication after acute myocardial infarction(AMI)are specified and the high-risk population of cardiac rupture is early identified,which is favorable for adopting intervention measures to reduce the occurrence of cardiac rupture at the early stage of acute myocardial infarction(AMI).Material and method:16,418 patients of acute myocardial infarction(AMI)who were hospitalized in Cardiology Department of Northern War Zone General Hospital(the former General Hospital of Shenyang Military Command)from January 2012 to December 2017 and84 patients with cardiac rupture complication during the hospitalization were taken as the research subjects in the study and identified as cardiac rupture group;the AMI patients without cardiac rupture who were hospitalized with the ones with cardiac rupture in the same year were randomly selected as non-cardiac rupture group as per the matching principle of1:6,and there were totally 503 patients as per the entry criteria.In addition,a total of 63 patients who were enrolled in 2017 and willing to accept the questionnaire were classified and determined by TCM constitution,including 16 patients with cardiac rupture.To summarize and analyze the related factors of heart rupture and TCM constitution.Logistic regression model was used to analyze the risk factors of complicated cardiac rupture in AMI patients and the physical tendency of TCM patients.Results:1 There were 16,418 AMI patients;thereinto,84 ones were with cardiac rupture and the occurrence rate is 0.51%.84 AMI patients with cardiac rupture complication were with the average age of(72.90±9.31);thereinto,there were 47 male patients and 37 females.2 The age of patients in cardiac rupture group was higher than the non-cardiac rupture[(72.90±9.31)vs(59.82±12.27),P<0.001].There were 47 males and 37 females in the cardiac rupture group,the number of males was more than females,the occurrence rate of males was higher than females(P<0.001).There was no obvious statistics difference between the groups with diabetes and smoking history(P>0.05).Statistics difference existed in both the groups of hypertension and chronic kidney disease(CKD)history[(66.67% vs 51.88%,P<0.05)and(47.56% vs 2.13%,P<0.001)].Statistics difference existed in if thrombolysis occurred between the groups of thrombolysis before hospitalization(3.80% vs 0.87%,P<0.05).3 Comparison of Clinical Data:(1)Through comparison of two groups,the statistics different didn't exist in sex of patients,heart rate and systolic pressure during the treatment(P>0.05).(2)Through comparison,the statistics different existed from the disease invasion to the treatment(P<0.001).(3)The ratio of patients with Killip ?~? in cardiac rupture group was higher than the one without cardiac rupture,and statistics different existed [(126.57 ±13.65)vs(137.91 ± 16.27),P<0.01].(4)The patient's echocardiography presented that no obvious difference existed in LV between two groups,the EF value of cardiac rupture group was lower than the one without cardiac rupture,and statistic difference existed between them[(46.48±11.75)vs(53.00±8.07),P<0.001].(5)The statistic difference existed in the white blood cell count,hemoglobin,renal insufficiency(the previous renal insufficiency history and creatinine clearance rate in hospitalization was <60%),CK-MB peak value,Tn T peak value and HDL-C(P<0.001).4 Comparison of Myocardial Infarction(MI): Through comparison,there was no statistics difference in these two groups of anterior myocardial infarction,acute inferior myocardial infarction,extensive anterior myocardial infarction and the myocardial infarction at other parts(P>0.05),non-ST segment elevated myocardial infarction(NSTEMI)was related to cardiac rupture,and statistic difference existed in these two groups(Person coefficient of contingency=0.274,P<0.001).5 Comparison of Medications: through comparison,the use rate of cardiac rupture group in DAPT,?-blocker,ACEI or ARB medication and statins was lower than the group without cardiac rupture,and statistic difference existed [79(94.0%)vs 495(98.4%),P<0.01] ?[48(57.1%)vs 340(67.6%),P<0.01]?[58(69.0%)vs 347(69.0%),P<0.01]?[71(84.5%)vs 481(95.6%),P<0.01].6 Identification and comparison of TCM constitution: among the 69 patients who received the questionnaire,qi deficiency and qi deficiency accounted for 27.5%,blood stasis and qi deficiency and qi deficiency accounted for 26.1% and ping ping and qi deficiency and qi deficiency accounted for 7.2%,among which 11 cases were in the cardiac rupture group,accounting for 34.4%,and 9 cases were in the blood stasis and qi deficiency and qi deficiency,accounting for 28.1%.There are significant statistical difference was found between the two groups(P<0.01).7 Multiple logistic aggression analysis and related factors of AMI complicated with CR.Logistic aggression analysis presented,advanced age(OR=1.08,95%CI:1.03~1.14),long time from disease invasion to hospitalization(OR=1.04,95%CI:1.01~1.07),rising of white blood cell count(OR=1.191,95%CI:1.083~1.308),anemia(OR=0.96,95%CI:0.93~0.99),high-density lipoprotein(HDL)(OR=10.41,95%CI:1.97~55.07)were independent risk factors for AMI complicated with CR.Complete revascularization(OR=0.17,95%CI:0.04~0.67)was protective factors.Conclusion:1 Main TCM constitution of AMI: qi deficiency and blood stasis,patients with yin deficiency are more prone to heart rupture.2 AMI patients with cardiac rupture was rare [0.51%(84/16418)],cardiac rupture easily occurred for the patients with advanced age,hypertension history and NSTEMI,3 Risk factors for AMI with cardiac rupture: advanced age,long time from disease invasion to hospitalization,rising of white blood cell count,anemia and rising of high-density lipoprotein(HDL).4 Protective factors for AMI complicated with cardiac rupture: complete revascularization. |
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