急性ST段抬高型心肌梗死合并心脏破裂回顾性分析

A retrospective analysis on acute ST-segment elevation myocardial infarction complicated by cardiac rupture

目的分析急性ST段抬高型心肌梗死(STEMI)合并心脏破裂临床特点,阐述治疗策略以及其短期生存率。方法回顾性分析2014年7月至2022年2月就诊于厦门大学附属心血管病医院心内科诊断为STEMI患者10817例,其中合并心脏破裂78例,根据其心脏破裂部位分为乳头肌破裂(PMR)组13例,心室游离壁破裂(VFWR)组25例和室间隔破裂(VSR)组40例。结果PMR、VFWR、VSR三组患者的年龄、性别、合并疾病、心肌梗死(心梗)再灌注时间窗以及是否多支血管病变比较无统计学意义,三组心脏破裂发生中位数时间有统计学意义(10 h、48 h、108 h,P<0.001);三组之间术前心电图表现、心肌梗死(心梗)相关罪犯血管比较差异有统计学意义(P<0.001,P<0.001);心梗相关罪犯血管亚组两两比较,PMR好发于LCX罪犯血管(61.5%),VSR好发于前降支(LAD)罪犯血管(86.2%),而VFWR各罪犯血管无统计学差异。STEMI并心脏破裂30 d存活率32%,1年存活率24.3%,三组生存曲线分析,乳头肌断裂组、游离壁破裂、室间隔穿孔组1年生存率分别为84.6%、4%、17.5%(P<0.001)。结论不同类型的心脏破裂事件发生时间、罪犯血管不同,STEMI合并心脏破裂1年存亡率低。

Objective To analyze the clinical characteristics of acute ST-segment elevation myocardial infarction(STEMI)complicated by cardiac rupture(CR),and describe treatment strategies and short-term survival rate.Methods The patients with acute STEMI(n=10817)were retrospectively analyzed in Department of Cardiology in Hospital of Cardiovascular Medicine Affiliated to Xiamen University from July 2014 to Feb.2022.There were 78 patients were complicated by CR.All patients were divided,according to CR positions,into group of papillary muscle rupture(PMR group,n=13),group of ventricular free wall rupture(VFWR group,n=25)and group of ventricular septal rupture(VSR group,n=40).Results There were no statistical differences in age,gender,complicated diseases,time window of myocardial infarction(MI)reperfusion and whether there were multiple vessel lesions among 3 groups.There was statistical difference in median time of CR occurred among PMR group(10 h),VFWR group(48 h)and VSR group(108 h,P<0.001).The comparison in preoperative ECG performance and MIrelated culprit vessels showed statistical differences among 3 groups(P<0.001,P<0.001).The pairwise comparison in subgroups of MI-related culprit vessels showed that CR was common in left circumflex of coronary artery(LCX)in PMR group(61.5%),in left anterior descending branch(LAD)in VSR group(86.2%),and had no statistical difference in MI-related culprit vessels in VFWR group.The 30-d survival rate was 32%and 1-y survival rate was 24.3%in STEMI patients complicated by CR.The results of survival curve analysis showed that 1-y survival rate was 84.6%in PMR group,4%in VSR group and 17.5%in VFWR group(P<0.001).Conclusion The occurrence time and culprit vessels are different in different types of CR.The patients with acute STEMI complicated by CR have lower 1-y survival rate.