急性ST段抬高心肌梗死患者发生心室游离壁破裂的危险因素分析

Risk factors of free wall rupture after acute ST-segment elevation myocardial infarction

目的分析急性ST段抬高心肌梗死(STEMI)患者发生心室游离壁破裂(FWR)的危险因素。方法回顾性分析武汉亚洲心脏病医院心内科2005年1月至2010年7月间确诊为STEMI患者(1247例)的临床资料,其中发生FWR的患者29例。将患者分为静脉溶栓组、直接经皮冠状动脉介入治疗(PPCI)组和未再灌注治疗组。结果 FWR总体发生率为2.3%,其中静脉溶栓治疗患者128例(10.2%),发生FWR 6例(4.7%);接受PPCI患者623例(50.0%),发生FWR2例(0.3%);未再灌注治疗患者496例(39.8%),发生FWR 21例(4.2%)。FWR组与非FWR组间临床特点比较,高龄(70.2±9.09岁比63.2±11.23岁,P=0.042)、合并高血压病史(62.1%比33.0%,P=0.013)、糖尿病病史(55.2%比23.5%,P=0.022)、合并心力衰竭(Killip分级≥Ⅱ级)(58.6%比21.9%,P=0.012),既往无陈旧性心肌梗死患者(10.3%比18.4%,P=0.018)等项的差异均有统计学意义;经多因素Logistic逐步回归分析显示年龄(≥70岁)、心功能(Killip≥Ⅱ)、静脉溶栓治疗、高敏C反应蛋白(hsCRP)>100 mg/L与心肌梗死后发生FWR相关。结论高龄、心力衰竭、静脉溶栓治疗以及hsCRP>100 mg/L是预测FWR发生的独立危险因素。

Objective To discuss the risk factors of free wall rupture （FWR） in acute ST-segment elevation myocardial infarction （STEMI） patients. Methods We retrospectively reviewed all patients （n=1247） with STEMI hospitalized in CCU from January 2005 to July 2010. Results FWR occurred in 29 patients（2.3%）. Of these 1247 patients, 128 （10.2%） patients received thrombolytic therapy, 623 （50.0%） patients underwent primary PCI. Compared to No-FWR group, FWR group has signiifcant differences in age （62.4±6.4 y vs. 66.6±8.3 y, P〈0.05）, hypertenion （29.7%vs. 21.8%, P〉0.05）, diabetes mellitu （55.2%vs. 23.5%, P=0.022）, presence of heart failure on admission （Killip≥Ⅱ） （ 16.4%vs. 34.0%, P〈0.05）, Peak value of hCRP[20.33 （15.02, 81.25） vs. 43.35 （16.56, 126.78）], no-history of pervious MI （10.3%vs. 18.4%, P=0.018）. Multivariate logistic regression showed that age （≥70 years old）, Killip≥Ⅱ, hCRP （ 〉 100 mg/L） and thrombolytic therapy were independent risk factors of FWR. Conclusions STEMI patients with advanced age, Killip≥Ⅱ, hCRP and thrombolytic therapy were more vulnerable of FWR.