急性心肌梗死后室间隔破裂的临床分析与危险分层。

Clinical analysis and risk stratification of ventricular septal rupture following acute myocardial infarction.

机构信息

Coronary Heart Disease Center, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China.

出版信息

Chin Med J (Engl). 2013 Nov;126(21):4105-8.

PMID:24229682

Abstract

BACKGROUND

Ventricular septal rupture (VSR) remains an infrequent but devastating complication of acute myocardial infarction (AMI). The best time to undergo surgical repair is controversial and there is currently no risk stratification for patients with VSR to guide treatment. The purpose of this study was to review the clinical outcomes of 70 patients with VSR, to analyze the short-term prognosis factors of VSR following AMI, and to make a risk stratification for patients with VSR.

METHODS

A total of 70 consecutive VSR patients following AMI treated in our hospital from January 2002 to October 2010 were enrolled in this study retrospectively. The difference of clinical characteristics were observed between patients with VSR who survived ≤30 days and survived >30 days. We analyzed the short-term prognosis factors of VSR and established the short-term prognosis index of VSR (SPIV) based on the Logistic regression analysis to stratify patients with VSR.

RESULTS

Among 12 354 patients with acute ST-segment elevation myocardial infarction, 70 (0.57%) patients (33 males and 37 females) were found to have VSR. The average age was (68.1±8.5) years. Fifty-four (77.1%) patients were diagnosed with an acute anterior infarction. Patients with VSR selected for surgical repair had better outcomes than patients treated conservatively; 1-year mortality 9.5% versus 87.8%, P < 0.005. Logistic regression analysis revealed that female (P = 0.013), anterior AMI (P = 0.023), non-ventricular aneurysm (P = 0.023), non-diabetes (P = 0.009), Killip class 3 or 4 (P = 0.022) and time from AMI to VSR less than 4 days (P = 0.027) were independent risk determinants for shortterm mortality. SPIV ≥9 indicates a high risk as the 30-day mortality is 77.4%; SPIV <8 indicates a low risk as the 30-day mortality is 28.6%; SPIV between 8 and 9 indicates a moderate risk.

CONCLUSIONS

VSR remains a rare but devastating complication of AMI. The independent risk determinants for short-term mortality of VSR were female gender, anterior AMI, non-ventricular aneurysm, non-diabetes, Killip class 3 or 4, and the time from AMI to VSR less than 4 days. It is reasonable to take more active treatments for the patients at high risk to save more lives.

摘要

背景

室间隔破裂（VSR）仍然是急性心肌梗死（AMI）的一种罕见但严重的并发症。进行手术修复的最佳时间存在争议，目前尚无 VSR 患者的风险分层来指导治疗。本研究旨在回顾 70 例 VSR 患者的临床结果，分析 AMI 后 VSR 的短期预后因素，并对 VSR 患者进行风险分层。

方法

回顾性分析 2002 年 1 月至 2010 年 10 月我院收治的 70 例连续 AMI 并发 VSR 患者的临床资料。观察 VSR 患者存活时间≤30 天和存活时间>30 天的患者临床特征的差异。分析 VSR 的短期预后因素，并基于 Logistic 回归分析建立 VSR 短期预后指数（SPIV），对 VSR 患者进行分层。

结果

在 12354 例急性 ST 段抬高型心肌梗死患者中，发现 70 例（0.57%）患者（33 例男性，37 例女性）并发 VSR。平均年龄为（68.1±8.5）岁。54 例（77.1%）患者诊断为急性前壁梗死。选择手术修复的 VSR 患者比保守治疗的患者预后更好；1 年死亡率为 9.5%比 87.8%，P<0.005。Logistic 回归分析显示，女性（P=0.013）、前壁 AMI（P=0.023）、非室性动脉瘤（P=0.023）、非糖尿病（P=0.009）、Killip 分级 3 或 4 级（P=0.022）和 AMI 至 VSR 的时间<4 天（P=0.027）是短期死亡率的独立危险因素。SPIV≥9 提示高风险，30 天死亡率为 77.4%；SPIV<8 提示低风险，30 天死亡率为 28.6%；SPIV 在 8 至 9 之间提示中风险。