介入治疗心肌梗死后室间隔穿孔的生存分析

Survival analysis of interventional therapy for post-myocardial infarction ventricular septal rupture

目的 对经皮介入治疗心肌梗死后室间隔穿孔的患者进行分析并随访,为临床心肌梗死后室间隔穿孔的患者管理和治疗提供参考。方法 纳入2016年至2021年因心肌梗死后室间隔穿孔在武汉亚洲心脏病医院进行经皮介入室间隔封堵术的患者。根据患者在住院期间是否死亡,将患者分为死亡组和生存组。对患者病历资料进行系统回顾及统计分析。结果 符合纳入标准的患者有25例,成功置入封堵器的22例(88%),其中住院期间死亡4例(18%),生存18例(82%)。死亡组和生存组相比,男性比例(100%比44.4%,P=0.049)、穿孔大小[(1.6±0.3)cm比(1.0±0.3)cm,P=0.012]及住院时间[(15.8±5.0)d比(23.8±6.9)d,P=0.04]存在统计学差异。术前收缩压(101±5.3比115.0±14.0,P=0.005)及术前IABP辅助时间/术前住院时间(1.0比0.6,P=0.039)反应术前血流动力学的两项指标存在统计学差异。穿孔至闭合的时间均在13d(13.5 d比13.89 d)。随访期间无新增死亡病例。结论 心肌梗死后室间隔穿孔是心肌梗死的致命并发症。当患者符合手术指征时,经皮介入封堵术是行之有效的治疗方案。排除手术时机的影响,术前血流动力学受损严重及术后并发症是术后死亡的高危因素。存活至出院的患者在长期随访中有很好的预后。

Objective This study analyzed and follow-up patients undergoing percutaneous interventional therapy for PMIVSR,aiming to provide a valuable reference for the management and treatment of patients with PMIVSR.Methods The patients who underwent percutaneous interventional ventricular septal closure for PMIVSR from 2016 to 2021 at Wuhan Asia Heart Hospital were included.The patients were divided into death and survival groups based on whether they died during their hospital stay.A systematic review and statistical analysis of the patient medical records were performed.Results 25 patients met the inclusion criteria and 22(88%)got successful occluder placement,with 4(18%)dead and 18(82%)alive.There were statistical differences in gender(100%vs.44.4%,P=0.049),perforation size[(1.6±0.3)cm vs.(1.0±0.3)cm,P=0.012]and length of stay[(15.8±5.0)d vs.(23.8±6.9)d,P=0.04]between the two groups.There were statistical differences in SBP(101±5.3 vs.115.0±14.0,P=0.005)and the preoperative IABP assistance time/preoperative stay(1.0 vs.0.6,P=0.039)which both two were the indicators reflecting the preoperative hemodynamics between the two groups.The time from perforation to closure was all 13 days(13.5 d vs.13.89 d).There were no new deaths during the follow-up period.Conclusions The PMIVSR is a fatal complication of myocardial infarction.Our data suggest that percutaneous interventional closure is an effective treatment when the patient meets the indications for the surgery.Excluding the influence of surgical timing,the severe preoperative hemodynamic damage and postoperative complications are the high risk factors for death after the surgery.The patients who survive to discharge would have a good prognosis in long-term follow-up.