Department of Internal Medicine, Reading Hospital-Tower Health System, West Reading, Pennsylvania.
Division of Cardiology, Reading Hospital-Tower Health System, West Reading, Pennsylvania.
Am J Cardiol. 2019 Apr 15;123(8):1239-1243. doi: 10.1016/j.amjcard.2019.01.033. Epub 2019 Mar 17.
ST-elevation myocardial infarction (STEMI) as a complication of infective endocarditis (IE) is a rarely reported entity. No clear guidelines exist with regards to the management of this medical emergency. We sought to systematically review the clinical presentation and management of this condition. We searched relevant articles on STEMI associated with IE and extracted data on demographic variables, key clinical characteristics upon presentation, treatment strategies, and clinical outcomes. We identified 100 patients from 95 articles. The mean age at presentation was 53 ± 17 years with male preponderance (n = 63, 63%, p = 0.01). Most patients (63 of 100, 63%) presented with STEMI as their first manifestation of IE, with others occurring at 15 ± 17 days after diagnosis of IE. Findings that suggested possible septic emboli were not consistently present, including history of prosthetic valve placement (15%), presence of other embolic disease (27%), fever (42%) increased leukocyte count (80%), and presence of murmur (88%). Atherosclerotic disease was absent in 95% on cardiac catheterization. Eleven patients receiving tissue plasminogen activator fared poorly, with 9 major bleeds; balloon angioplasty was successful in 56% (9 of 16 cases), aspiration thombectomy in 68% (21 of 31 cases), and coronary stenting in 81% (14 of 16 cases). The 30-day mortality was 43%. In conclusion, patients with STEMI in the face of recent IE, new precordial murmur, fever, increased leukocyte count or other embolic events, septic emboli should be considered as a cause for STEMI. Best practices for management are not known, but thrombolytics appear to carry significant bleeding and embolic risks.
ST 段抬高型心肌梗死（STEMI）作为感染性心内膜炎（IE）的并发症是一种罕见的疾病。目前尚无明确的指南来指导这种医疗急症的处理。我们旨在对这种疾病的临床表现和处理方法进行系统回顾。我们检索了与 IE 相关的 STEMI 的相关文章，并提取了人口统计学变量、就诊时的关键临床特征、治疗策略和临床结局的数据。我们从 95 篇文章中确定了 100 名患者。发病时的平均年龄为 53 ± 17 岁，男性居多（n = 63，63%，p = 0.01）。大多数患者（100 例中的 63 例，63%）首次出现 IE 时即表现为 STEMI，另有其他患者在 IE 诊断后 15 ± 17 天出现该症状。可能提示有感染性栓子的发现并不一致，包括人工瓣膜置入史（15%）、其他栓塞性疾病（27%）、发热（42%）、白细胞计数升高（80%）和心杂音（88%）。95%的患者在进行心脏导管检查时未见动脉粥样硬化性疾病。11 名接受组织型纤溶酶原激活剂治疗的患者预后较差，9 名患者发生大出血；血管成形术成功 56%（16 例中的 9 例），抽吸血栓切除术成功 68%（31 例中的 21 例），冠状动脉支架置入术成功 81%（16 例中的 14 例）。30 天死亡率为 43%。总之，对于近期发生 IE、新出现心前区杂音、发热、白细胞计数升高或其他栓塞事件的 STEMI 患者，应考虑感染性栓子为 STEMI 的病因。目前尚不清楚最佳的治疗方法，但溶栓治疗似乎存在显著的出血和栓塞风险。
