Critical Medicine Department, Peking University People's Hospital, Beijing, China.
Cardiac Surgery Department, Peking University People's Hospital, Beijing, China.
Heart Surg Forum. 2021 Aug 26;24(4):E757-E763. doi: 10.1532/hsf.3921.
To explore the clinical characteristics of acute myocardial infarction (AMI) with ventricular septal perforation (VSR), the prognosis comparison of different treatment methods, and analysis of related risk factors.
From January 2006 to February 2020, 29 patients with AMI and VSR diagnosed in the People's Hospital of Peking University were selected as the study group. Among them, 16 cases were male (55.2%), 13 cases were female (44.8%), and the average age was 64.69 ± 10.32 years old. They were divided into two groups: the survival group (N = 16) and non-survival group (N = 13), according to whether they survived within 30 days of surgical or drug conservative treatment. The clinical characteristics, coronary angiography, and treatment of the two groups were summarized, and the prognosis and related risk factors were analyzed.
There was no significant difference in the basic clinical characteristics between the two groups (P > 0.05). Compared with the results of coronary angiography in the two groups, the proportion of the culprit vessel, which was a simple anterior descending branch in the non-survival group, was higher than that in the survival group. There was a statistical difference between the two groups (P < 0.05). The perioperative data of the two groups showed that the proportion of patients with complete revascularization, simultaneous bypass, and recanalization of culprit vessels in the survival group was significantly higher than that in the non-survival group (P < 0.05). However, the incidence of postoperative low cardiac output and mortality during hospitalization in the survival group were significantly lower than those in the non-survival group (P < 0.05). Logistic regression analysis showed that complete revascularization (OR = 0.021, 95% CI 0.001-0.374, P = 0.009) and recanalization of culprit vessels (OR = 0.045, 95% CI 0.004-0.548, P = 0.015) were independent risk factors for 30-day mortality. Kaplan-Meier survival curve showed that during the follow-up period, the long-term survival rate of patients with operation and complete revascularization was significantly higher than that of patients with drug conservative treatment and incomplete revascularization. There was a statistical difference between the two groups (P < 0.05).
Complete revascularization and recanalization of culprit vessels are independent risk factors for 30-day mortality in patients with AMI and VSR. The long-term survival rate of patients after surgery and complete revascularization is significantly higher than that of patients with conservative medical treatment and incomplete revascularization. Surgery and complete revascularization are important factors affecting the long-term prognosis of patients with AMI and VSR.
探讨急性心肌梗死（AMI）合并室间隔穿孔（VSR）的临床特点，不同治疗方法的预后比较，并分析相关的危险因素。
选取 2006 年 1 月至 2020 年 2 月在北京大学人民医院确诊为 AMI 合并 VSR 的 29 例患者为研究对象，其中男 16 例（55.2%），女 13 例（44.8%），平均年龄（64.69±10.32）岁。根据手术或药物保守治疗后 30 天内是否存活分为存活组（N=16）和未存活组（N=13）。总结两组的临床特征、冠状动脉造影及治疗情况，并分析其预后及相关危险因素。
两组患者的基本临床特征比较差异无统计学意义（P＞0.05）。与两组冠状动脉造影结果比较，未存活组罪犯血管单纯前降支的比例高于存活组，差异有统计学意义（P＜0.05）。两组围术期资料比较，存活组完全血运重建、同期旁路、罪犯血管再通的患者比例明显高于未存活组（P＜0.05）。但存活组术后低心排血量及住院期间病死率明显低于未存活组（P＜0.05）。Logistic 回归分析显示，完全血运重建（OR=0.021，95%CI 0.001～0.374，P=0.009）和罪犯血管再通（OR=0.045，95%CI 0.004～0.548，P=0.015）是 30 天死亡的独立危险因素。Kaplan-Meier 生存曲线显示，随访期间手术治疗且完全血运重建患者的长期生存率明显高于药物保守治疗且不完全血运重建患者，差异有统计学意义（P＜0.05）。
完全血运重建和罪犯血管再通是 AMI 合并 VSR 患者 30 天内死亡的独立危险因素。手术治疗且完全血运重建患者的长期生存率明显高于药物保守治疗且不完全血运重建患者。手术和完全血运重建是影响 AMI 合并 VSR 患者长期预后的重要因素。
