Liu T S, Huang Z H, Zhao Y, Zheng J B, Dong R
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2022 Jun 14;102(22):1653-1659. doi: 10.3760/cma.j.cn112137-20211112-02520.
To in vestigate the death-related risk factors of surgical treatment of myocardial infarction (MI) combined with ventricular septal rupture (VSR). The clinical data of patients (68 cases) with ventricular septal rupture after myocardial infarction (PI-VSR) from January 2008 to December 2020 in Beijing Anzhen Hospital were retrospectively selected and analyzed. We followed up the surviving patients and divided them into the survival group and the death group according to the perioperative and follow-up results. The univariate analysis was performed on various indicators, and the Cox regression analysis was used to analyze the risk factors related to postoperative death. A total of 68 patients (42 were male and 26 were female, with age 44-82 (64.3±8.2) years after surgical treatment of myocardial infarction combined with ventricular septal rupture were enrolled, 9 patients died during the perioperative period, 59 surviving patients were followed up for 0.1-10.5 years(mean, 4 years), and 7 deaths during follow-up. Based on this, 52 patients were selected as the survival group while 16 patients as the death group. The results of univariate analysis showed that age, VSR to operation time less than 7 days, killip grade ≥ grade 3, cardiogenic shock, preoperative use of IABP, emergent surgery were related to postoperative death. The factors with <0.2 factors in univariate analysis were selected into the multivariate Cox regression analysis. Age ([=1.110(1.012-1.217), =0.026], platelet count [=0.990(0.981-0.999), =0.031], D dimer (=1.002[1.001-1.003], =0.003), cardiogenic shock (=6.084[1.729-21.405], =0.005) were independent risk factors for postoperative death. All patients were followed up, the survival rate of 2-year, 4-year, 6-year, 8-year, and 10-year was 77.5%, 77.5%, 71.0%, 71.0%, and 71.0%, respectively. Age, platelet count, D-dimer, and cardiogenic shock are risk factors for death after surgical treatment of myocardial infarction combined with ventricular septal rupture. Surgery is an effective method for the treatment of myocardial infarction combined with ventricular septal rupture. Long-term prognosis of the surviving patients during perioperative are relatively better.
探讨心肌梗死（MI）合并室间隔破裂（VSR）手术治疗的死亡相关危险因素。回顾性选取并分析2008年1月至2020年12月在北京安贞医院心肌梗死后室间隔破裂（PI-VSR）患者（68例）的临床资料。对存活患者进行随访，根据围手术期及随访结果将其分为存活组和死亡组。对各项指标进行单因素分析，并采用Cox回归分析术后死亡相关危险因素。共纳入68例心肌梗死合并室间隔破裂手术治疗患者（男42例，女26例，年龄44 - 82（64.3±8.2）岁），9例患者在围手术期死亡，59例存活患者随访0.1 - 10.5年（平均4年），随访期间7例死亡。据此，选取52例患者作为存活组，16例患者作为死亡组。单因素分析结果显示，年龄、VSR至手术时间小于7天、Killip分级≥3级、心源性休克、术前使用主动脉内球囊反搏（IABP）、急诊手术与术后死亡相关。将单因素分析中P<0.2的因素纳入多因素Cox回归分析。年龄（β=1.110（1.012-1.217），P=0.026）、血小板计数（β=0.990（0.981-0.999），P=0.031）、D-二聚体（β=1.002[1.001-1.003]，P=0.003）、心源性休克（β=6.084[1.729-21.405]，P=0.005）是术后死亡的独立危险因素。对所有患者进行随访，2年、4年、6年、8年和10年生存率分别为77.5%、77.5%、71.0%、71.0%和71.0%。年龄、血小板计数、D-二聚体及心源性休克是心肌梗死合并室间隔破裂手术治疗后死亡危险因素。手术是治疗心肌梗死合并室间隔破裂的有效方法。存活患者围手术期长期预后相对较好。
