急性心肌梗死后室间隔穿孔介入封堵患者院内死亡的相关因素分析

Transcatheter closure of post-infarction ventricular septal rupture: In-hospital mortality and relative factors

目的:探讨急性心肌梗死(AMI)后室间隔穿孔(VSR)介入封堵患者的院内死亡率及相关因素。方法:回顾性分析我院冠心病监护病房(CCU)2018年1月至2020年12月,收治的47例AMI后VSR(PI-VSR)并行介入封堵治疗患者的临床资料,其中女性30例、男性17例,平均年龄(68.21±6.20)岁,根据是否发生院内死亡分为院内死亡组(n=9)和院内存活组(n=38),采用单因素方差分析及Logistic多因素回归分析患者院内死亡的相关因素。结果:PI-VSR行介入封堵治疗患者9例死亡、38例存活,院内病死率为19.1%。单因素方差分析显示,患者入住CCU时心功能Ⅲ~Ⅳ级(Killip分级)、肌酐水平、序贯器官衰竭评分(SOFA评分),以及术后肌酐水平、连续肾脏替代疗法(CRRT)、封堵相关机械并发症、消化道出血与患者院内死亡相关(P均<0.05)。Logistic多因素回归分析显示,患者入住CCU时SOFA评分(OR=1.667,95%CI:1.105~2.513,P=0.015)及合并封堵相关机械并发症(OR=22.884,95%CI:1.053~497.172,P=0.046)、CRRT治疗(OR=19.483,95%CI:1.835~206.821,P=0.014)是患者院内死亡率的危险因素。结论:患者入住CCU时的SOFA评分、合并封堵相关机械并发症及CRRT治疗是PI-VSR行介入封堵治疗患者院内死亡的危险因素。

Objective: To analyze the in-hospital mortality and related factors of transcatheter closure in patients with ventricular septal rupture(VSR) after acute myocardial infarction(AMI). Methods: A total of 47 consecutive patients with post-infarction VSR(PI-VSR) admitted to Coronary Care Unit(CCU) of our hospital from January 2018 to December 2020 were enrolled and analyzed retrospectively. There were 30 females and 17 males with an average age of(68.21±6.20) years. They were divided into inhospital death group(n =9) and in-hospital survival group(n =38). One way ANOVA and multivariate logistic regression were used to analyze the relative factors of in-hospital mortality. Results: The inhospital mortality of PI-VSR patients was 19.1%. Univariate analysis of variance showed that Killip class Ⅲ-Ⅳ, creatinine level, Sequential organ failure assessment score(SOFA score) at admission of CCU,postoperative creatinine level, continuous renal replacement therapy(CRRT), mechanical complications related to transcatheter closure and gastrointestinal bleeding during hospitalization were associated with inhospital death(P < 0.05). Logistic regression analysis reflected that SOFA score at admission of CCU(OR=1.667,95%CI:1.105-2.513,P=0.015),mechanical complications related to transcatheter closure(OR=22.884,95% CI:1.053-497.172,P=0.046)and CRRT(OR=19.483,95% CI:1.835-206.821,P =0.014) during hospitalization were independent risk factors of in-hospital mortality. Conclusions:The day 1 high SOFA score in CCU, mechanical complications related to transcatheter closure and CRRT treatment during hospital are independent risk factors of in-hospital mortality in the PI-VSR patients with transcatheter closure.