Xiamen Cardiovescular Hospital Xiamen University, Xiamen, CN.
Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, CN.
Glob Heart. 2022 Sep 30;17(1):69. doi: 10.5334/gh.1155. eCollection 2022.
Cardiac rupture is one of the fatal complications of ST-Segment Elevation Myocardial Infarction (STEMI) in the primary percutaneous coronary intervention (PPCI) era. The present study aims to identify risk factors of cardiac rupture among patients suffering from STEMI, treated with early and late PPCI.
This is a multicenter retrospective cohort study involving STEMI patients with cardiac rupture (CR group), matched with STEMI patients without CR (control group) in a 1:5 ratio. They were divided into the early (≤ 6 h) and the late (> 6 h) PCI groups. Multivariable logistic regression was utilized to identify risk factors for cardiac rupture.
Seventy-four patients in the CR and 370 in the control group were included. Multivariable regression identified lateral infarction (OR = 11.89, 95% CI 2.22-63.81, p < 0.01) in the early PCI phase as a significant risk factor for cardiac rupture. Thrombolysis in myocardial infarction (TIMI) grade 0-1 (early PCI: OR = 4.16, 95% CI 1.33-13.0, p = 0.01; late PCI: OR = 4.46, 95% CI 1.59-12.54, p < 0.01) was a risk factor for both early and late PCI groups. In contrast, TIMI grade 2 was associated with a higher rupture risk within the late (OR = 16.87, 95% CI 3.83-74.19, p < 0.001) but not for the early (OR = 5.44, 95% CI 0.76-39.07, p = 0.09) PCI groups. STEMI combined with Killip IV was associated with a higher rupture risk for the late PCI group (OR = 1.43, 95% CI 1.03-1.99, p = 0.04). Intra-aortic balloon pump (IABP) was protective against cardiac rupture within early PPCI (OR = 0.18, 95% CI 0.04-0.89, p = 0.04). In contrast, glycoprotein IIb/IIIa inhibitors were associated with lower rupture risks in both the early and late groups (early PCI: OR = 0.38, 95% CI 0.17-0.87, p = 0.02; late PCI: OR = 0.33, 95% CI 0.15-0.75, p < 0.01).
No reflow or slow blood flow is associated with a higher risk of cardiac rupture in early and late PCI patients. Glycoprotein IIb/IIIa inhibitors are beneficial in preventing heart rupture, and the use of IABP in early PPCI is also helpful in preventing heart rupture.
在直接经皮冠状动脉介入治疗（PPCI）时代，心破裂是 ST 段抬高型心肌梗死（STEMI）的致命并发症之一。本研究旨在确定在接受早期和晚期 PPCI 治疗的 STEMI 患者中心破裂（CR）的风险因素。
这是一项多中心回顾性队列研究，纳入了 STEMI 合并心破裂（CR 组）和 STEMI 无 CR 患者（对照组），按 1:5 比例匹配。他们分为早期（≤6 h）和晚期（>6 h）PCI 组。采用多变量逻辑回归识别心破裂的风险因素。
CR 组 74 例，对照组 370 例。多变量回归确定了早期 PCI 阶段的外侧梗死（OR=11.89，95%CI 2.22-63.81，p<0.01）是心破裂的显著危险因素。心肌梗死溶栓治疗（TIMI）分级 0-1（早期 PCI：OR=4.16，95%CI 1.33-13.0，p=0.01；晚期 PCI：OR=4.46，95%CI 1.59-12.54，p<0.01）是早期和晚期 PCI 组的风险因素。相反，TIMI 分级 2 与晚期 PCI 组的更高破裂风险相关（OR=16.87，95%CI 3.83-74.19，p<0.001），但与早期 PCI 组无关（OR=5.44，95%CI 0.76-39.07，p=0.09）。STEMI 合并 Killip IV 与晚期 PCI 组更高的破裂风险相关（OR=1.43，95%CI 1.03-1.99，p=0.04）。主动脉内球囊泵（IABP）对早期 PPCI 中的心破裂具有保护作用（OR=0.18，95%CI 0.04-0.89，p=0.04）。相反，糖蛋白 IIb/IIIa 抑制剂在早期和晚期组中均与较低的破裂风险相关（早期 PCI：OR=0.38，95%CI 0.17-0.87，p=0.02；晚期 PCI：OR=0.33，95%CI 0.15-0.75，p<0.01）。
无再流或血流缓慢与早期和晚期 PCI 患者心破裂风险增加相关。糖蛋白 IIb/IIIa 抑制剂有利于预防心破裂，早期 PPCI 中使用 IABP 也有助于预防心破裂。
