胸痛中心模式下急性ST段抬高型心肌梗死并发心室游离壁破裂患者的临床特征

Clinical characteristics of patients with acute ST-segment elevation myocardial infarction complicated with free wall rupture in the center mode of chest pain

目的:探讨胸痛中心模式下急性ST段抬高型心肌梗死(STEMI)并发心室游离壁破裂(FWR)患者的临床特征。方法:收集STEMI并发FWR患者177例,将是否在胸痛中心模式下就诊分为胸痛中心组(89例)和非胸痛中心组(88例)。回顾性分析比较2组患者的基本资料、临床指标及治疗等情况,采用多因素Logistic回归分析发生FWR的危险因素。结果:与非胸痛中心组比较,胸痛中心组发病到首次医疗接触(S2FMC)时间更长,时间≤3 d的FWR发生率、接受经皮冠状动脉介入(PCI)比例、超敏C-反应蛋白(hs-CRP)水平更高及下壁心肌梗死例数更多;而FWR平均天数较短,左心室射血分数<40%患者比例更低(P均<0.05)。多因素Logistic回归分析显示,S2FMC时间长(OR=1.018,P=0.023)和hs-CRP水平高(OR=1.198,P=0.011)是发生早期FWR(≤3 d)的独立危险因素。结论:胸痛中心模式下患者血运重建比例虽有升高,但心脏破裂(CR)时间提前,这可能与S2FMC时间延长及hs-CRP升高相关。

Objective:To investigate the clinical characteristics of patients with acute ST-segment elevation myocardial infarction(STEMI)complicated with free wall rupture(FWR)in chest pain center mode.Methods:A total of 177 patients with STEMI complicated with FWR were collected and divided into chest pain center group(89 cases)and non-chest pain center group(88 cases).The basic data,clinical indicators and treatment of the two groups were retrospectively analyzed and compared.Multivariate Logistic regression analysis was used to analyze the risk factors of FWR.Results:Compared with the non-chest pain center group,the time from onset to first medical contact(S2FMC)was longer,the incidence of FWR≤3 d,the proportion of percutaneous coronary intervention(PCI),the level of high-sensitivity C-reactive protein(hs-CRP)and the number of inferior myocardial infarction were higher in the chest pain center group,and the average days of FWR were shorter,and the proportion of left ventricular ejection fraction<40%was lower(P<0.05).Multivariate Logistic regression analysis showed that long S2FMC time(OR=1.019,P=0.023)and high hs-CRP(OR=1.198,P=0.011)were independent risk factors for early FWR(≤3 d).Conclusion:Although the proportion of revascularization in patients with chest pain center mode increased,the time of cardiac rupture was advanced,which may be related to the prolongation of S2FMC time and the increase of hs-CRP.