Katayama Toshiro, Nakashima Hiroshi, Takagi Chisa, Honda Yukiharu, Suzuki Shin, Iwasaki Yoshihiro, Yamamoto Tadashi, Yoshioka Masato, Yano Katsusuke
Department of Cardiovascular Medicine and Course of Medical and Dental Science, Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan.
Circ J. 2006 May;70(5):530-5. doi: 10.1253/circj.70.530.
The predictors of cardiac rupture (CR) in patients with acute myocardial infarction (AMI) treated with successful primary coronary angioplasty have not been identified.
Of 433 consecutive AMI subjects who underwent reperfusion by primary coronary angioplasty within 24 h of onset, CR occurred in 11 (2.5%), free wall rupture in 9, and ventricular septal perforation in 2. Rates of females, diabetes mellitus and anterior infarction were higher in the group of CR patients than in the others (p < 0.05). There were no significant differences between the 2 groups in terms of left ventricular (LV) function soon after recanalization, such as LV ejection fraction, regional wall motion, or end-diastolic volume index. Plasma levels of both high-sensitivity C-reactive protein (hsCRP) and serum amyloid-A protein (SAA) were significantly higher in the CR patients than in the others (hsCRP: 6.7 +/- 6.7 mg/dl vs 3.3 +/- 3.8 mg/dl, p = 0.007; SAA: 699 +/- 812 microg/dl vs 208 +/- 273 microg/dl, p < 0.0001). Multivariate analysis identified SAA as an independent predictor of CR (risk ratio: 8.8, 95% confidence interval: 1.7-25.6, p < 0.05). Conclusions In patients with AMI treated with primary coronary angioplasty, inflammation may be closely related to CR, for which SAA is a useful predictor.
在接受成功的直接冠状动脉血管成形术治疗的急性心肌梗死（AMI）患者中，心脏破裂（CR）的预测因素尚未明确。
在433例发病24小时内接受直接冠状动脉血管成形术再灌注治疗的连续AMI患者中，11例（2.5%）发生CR，其中9例为游离壁破裂，2例为室间隔穿孔。CR患者组中女性、糖尿病和前壁梗死的发生率高于其他组（p<0.05）。两组在再通后不久的左心室（LV）功能方面，如LV射血分数、节段性室壁运动或舒张末期容积指数，无显著差异。CR患者的高敏C反应蛋白（hsCRP）和血清淀粉样蛋白A（SAA）血浆水平均显著高于其他患者（hsCRP：6.7±6.7mg/dl对3.3±3.8mg/dl，p = 0.007；SAA：699±812μg/dl对208±273μg/dl，p<0.0001）。多变量分析确定SAA为CR的独立预测因素（风险比：8.8，95%置信区间：1.7 - 25.6，p<0.05）。结论在接受直接冠状动脉血管成形术治疗的AMI患者中，炎症可能与CR密切相关，SAA是其有用的预测指标。
