Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota; Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
University of Minnesota School of Medicine, Minneapolis, Minnesota.
Am J Cardiol. 2020 Oct 15;133:32-38. doi: 10.1016/j.amjcard.2020.07.043. Epub 2020 Jul 28.
There are limited data on the prevalence and an outcome of left ventricular (LV) aneurysms following acute myocardial infarction (AMI). Using the National Inpatient Sample during 2000 to 2017, a retrospective cohort of AMI admissions was evaluated for LV aneurysms. Complications included ventricular arrhythmias, mechanical, cardiac arrest, pump failure, LV thrombus, and stroke. Outcomes of interest included in-hospital mortality, temporal trends, complications, hospitalization costs, and length of stay. A total 11,622,528 AMI admissions, with 17,626 (0.2%) having LV aneurysms were included. The LV aneurysm cohort was more often female, with higher comorbidity, and admitted to large urban hospitals (all p < 0.001). In 2017, compared with 2000, there was a slight increase in LV aneurysms prevalence in those with (adjusted odds ratio [aOR] 1.57 [95% confidence interval {CI} 1.41 to 1.76]) and without (aOR 1.13 [95% CI 1.00 to .127]) ST-segment-elevation AMI (p < 0.001 for trend). LV aneurysms were more commonly noted with anterior ST-segment-elevation AMI (31%) compared with inferior (12.3%) and other (7.9%). Ventricular arrhythmias (17.6% vs 8.0%), mechanical complications (2.6% vs 0.2%), cardiac arrest (7.1% vs 5.0%), pump failure (26.3% vs 16.1%), cardiogenic shock (10.0% vs 4.8%) were more common in the LV aneurysm cohort (all p < 0.001). Those with LV aneurysms had comparable in-hospital mortality compared with those without (7.4% vs 6.2%; aOR 1.02 [95% CI 0.90 to 1.14]; p = 0.43). The LV aneurysm cohort had longer length of hospital stay, higher hospitalization costs, and fewer discharges to home. In conclusion, LV aneurysms were associated with higher morbidity, more frequent complications, and greater in-hospital resource utilization, without any differences in in-hospital mortality in AMI.
目前关于急性心肌梗死（AMI）后左心室（LV）瘤的患病率和结局的数据有限。本研究使用 2000 年至 2017 年期间的全国住院患者样本，对 AMI 入院患者的 LV 瘤进行了回顾性队列评估。并发症包括室性心律失常、机械性、心脏骤停、泵衰竭、LV 血栓和中风。感兴趣的结局包括院内死亡率、时间趋势、并发症、住院费用和住院时间。共纳入 11622528 例 AMI 入院患者，其中 17626 例（0.2%）患有 LV 瘤。LV 瘤组更常见于女性，合并症更多，且入住大型城市医院（均 P < 0.001）。与 2000 年相比，2017 年 ST 段抬高 AMI 患者（校正优势比 [aOR] 1.57 [95%置信区间 {CI} 1.41 至 1.76]）和非 ST 段抬高 AMI 患者（aOR 1.13 [95%CI 1.00 至.127]）中 LV 瘤的患病率略有增加（趋势 P < 0.001）。LV 瘤更常见于前壁 ST 段抬高 AMI（31%），而不是下壁（12.3%）和其他部位（7.9%）。室性心律失常（17.6% vs 8.0%）、机械性并发症（2.6% vs 0.2%）、心脏骤停（7.1% vs 5.0%）、泵衰竭（26.3% vs 16.1%）、心源性休克（10.0% vs 4.8%）在 LV 瘤组更为常见（均 P < 0.001）。与无 LV 瘤的患者相比，LV 瘤患者的院内死亡率相似（7.4% vs 6.2%；aOR 1.02 [95%CI 0.90 至 1.14]；P=0.43）。LV 瘤组的住院时间更长，住院费用更高，出院回家的比例更低。总之，LV 瘤与更高的发病率、更频繁的并发症和更大的院内资源利用相关，但 AMI 患者的院内死亡率无差异。
