Kwok Chun Shing, Qureshi Adnan I, Will Maximillian, Schwarz Konstantin, Lip Gregory Y H, Borovac Josip A
Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK.
Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO 65211, USA.
J Cardiovasc Dev Dis. 2024 Feb 15;11(2):59. doi: 10.3390/jcdd11020059.
ST-elevation myocardial infarction (STEMI) is a life-threatening emergency that can result in cardiac structural complications without timely revascularization. A retrospective study from the National Inpatient Sample included all patients with a diagnosis of STEMI between 2016 and 2020. Primary outcomes of interest were in-hospital mortality, length of stay (LoS), and healthcare costs for patients with and without structural complications. There were 994,300 hospital admissions included in the analysis (median age 64 years and 32.2% female). Structural complications occurred in 0.78% of patients. There was a three-fold increase in patients with cardiogenic shock (41.6% vs. 13.6%) and in-hospital mortality (30.6% vs. 10.7%) in the group with structural complications. The median LoS was longer (5 days vs. 3 days), and the median cost was significantly greater (USD 32,436 vs. USD 20,241) for patients with structural complications. After adjustments, in-hospital mortality was significantly greater for patients with structural complications (OR 1.99, 95% CI 1.73-2.30), and both LoS and costs were greater. There was a significant increase in mortality with ruptured cardiac wall (OR 9.16, 95% CI 5.91-14.20), hemopericardium (OR 3.20, 95% CI 1.91-5.35), and ventricular septal rupture (OR 2.57, 95% CI 1.98-3.35) compared with those with no complication. In conclusion, structural complications in STEMI patients are rare but potentially catastrophic events.
ST段抬高型心肌梗死（STEMI）是一种危及生命的急症，若不及时进行血运重建，可能导致心脏结构并发症。一项来自全国住院患者样本的回顾性研究纳入了2016年至2020年间所有诊断为STEMI的患者。感兴趣的主要结局是有或无结构并发症患者的住院死亡率、住院时间（LoS）和医疗费用。分析纳入了994300例住院病例（中位年龄64岁，女性占32.2%）。0.78%的患者出现结构并发症。有结构并发症的患者发生心源性休克（41.6%对13.6%）和住院死亡率（30.6%对10.7%）增加了两倍。有结构并发症患者的中位LoS更长（5天对3天），中位费用显著更高（32436美元对20241美元）。调整后，有结构并发症患者的住院死亡率显著更高（OR 1.99，95%CI 1.73 - 2.30），LoS和费用也更高。与无并发症患者相比，心脏壁破裂（OR 9.16，95%CI 5.91 - 14.20）、心包积血（OR 3.20，95%CI 1.91 - 5.35）和室间隔破裂（OR 2.57，95%CI 1.98 - 3.35）患者的死亡率显著增加。总之，STEMI患者的结构并发症虽罕见，但可能是灾难性事件。
