Nishida Takeshi, Sakakura Kenichi, Wada Hiroshi, Ikeda Nahoko, Sugawara Yoshitaka, Kubo Norifumi, Ako Junya, Momomura Shin-Ichi
Division of Cardiovascular Medicine, Department of Integrated Medicine I, Jichi Medical University Saitama Medical Center, Amanuma 1-847, Omiya, Saitama 330-8503, Japan.
Heart Vessels. 2012 Sep;27(5):475-9. doi: 10.1007/s00380-011-0179-4. Epub 2011 Aug 13.
Ventricular septal perforation (VSP) is a serious complication associated with acute myocardial infarction (MI). The purpose of this study was to investigate the determinants of in-hospital death in patients with postinfarction VSP. Between January 1990 and April 2010, we identified 37 patients from our hospital records. Univariate analysis and multivariate logistic regression analysis were performed to find the determinants of in-hospital death. In-hospital mortality was 35% (13/37 patients). History of hypertension (P = 0.03), percutaneous coronary intervention (P = 0.04), and preoperative percutaneous cardiopulmonary support (P = 0.04) were associated with in-hospital death, whereas history of hyperlipidemia was associated with in-hospital survival. The interval from MI to VSP in survivors was significantly longer than that in nonsurvivors (P < 0.01). In multivariate logistic regression analysis, a shorter interval from MI to VSP (odds ratio 0.57, 95% confidence interval 0.34-0.95, P = 0.03) was found to be an independent predictor of in-hospital death. In conclusion, in-hospital mortality was high in patients with postinfarction VSP. A shorter interval from MI to VSP was a significant independent predictor of in-hospital death.
室间隔穿孔（VSP）是急性心肌梗死（MI）相关的一种严重并发症。本研究的目的是调查心肌梗死后VSP患者院内死亡的决定因素。在1990年1月至2010年4月期间，我们从医院记录中识别出37例患者。进行单因素分析和多因素逻辑回归分析以找出院内死亡的决定因素。院内死亡率为35%（13/37例患者）。高血压病史（P = 0.03）、经皮冠状动脉介入治疗（P = 0.04）和术前经皮心肺支持（P = 0.04）与院内死亡相关，而高脂血症病史与院内生存相关。存活者从MI到VSP的时间间隔显著长于非存活者（P < 0.01）。在多因素逻辑回归分析中，发现从MI到VSP的时间间隔较短（比值比0.57，95%置信区间0.34 - 0.95，P = 0.03）是院内死亡的独立预测因素。总之，心肌梗死后VSP患者的院内死亡率较高。从MI到VSP的时间间隔较短是院内死亡的显著独立预测因素。
