Luo Wenjian, Wen Li, Zhang Jinning, Zhao Junyong, Wang Zelan, Luo Xiaolin, Pi Shixian, Chen Yang, Zhang Jiawen, Li Tao, Zhang Zhihui, Luo Dan, Qin Zhexue, Yu Shiyong
Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China.
Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
J Cardiothorac Surg. 2024 Oct 1;19(1):571. doi: 10.1186/s13019-024-03077-z.
Post-myocardial infarction ventricular septal rupture (PIVSR) is one of the most severe types of mechanical complications after acute myocardial infarction (AMI) with high mortality and poor prognosis. The risk factors for short-term mortality of patients with PIVSR may be not widely recognized. We aimed to assess the prevalence and short-term mortality risk predictors of PIVSR.
A total of 62 patients with a diagnosis of PIVSR were admitted to three top general public hospitals in Chongqing, China. Clinical characteristics and short-term outcomes of patients with PIVSR were compared. Predictors of PIVSR were assessed using logistic regression analysis.
Mean age was 70.7 ± 10.7 years (38.7% female). The overall in-hospital mortality of PIVSR remained high (71%). Most (47/62) of the patients were in Killip class III or IV at the time of rupture diagnosis. Logistic regression analysis revealed that white blood cell count (WBC, OR 1.619, 95% CI 1.172-2.237, P = 0.005), cardiogenic shock (OR 47.706, 95%CI 2.859-795.945, P = 0.007) and left ventricular ejection fraction (LVEF, OR 0.803, 95%CI 0.689-0.936, P = 0.009) were independent risk factors of in-hospital early mortality. The nomogram developed for predicting the risk of short-term mortality showed a robust discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.956 (95%CI 0.912-1.000).
The short-term mortality of PIVSR remained high. WBC, cardiogenic shock, and LVEF were the independent predictive factors of short-term mortality. Our nomogram might be used to predict early mortality of patients with PIVSR.
心肌梗死后室间隔破裂（PIVSR）是急性心肌梗死（AMI）后最严重的机械性并发症之一，死亡率高且预后差。PIVSR患者短期死亡的危险因素可能尚未得到广泛认识。我们旨在评估PIVSR的患病率和短期死亡风险预测因素。
共有62例诊断为PIVSR的患者入住中国重庆的三家顶级综合公立医院。比较了PIVSR患者的临床特征和短期结局。使用逻辑回归分析评估PIVSR的预测因素。
平均年龄为70.7±10.7岁（女性占38.7%）。PIVSR的总体院内死亡率仍然很高（71%）。大多数（47/62）患者在破裂诊断时处于Killip III级或IV级。逻辑回归分析显示，白细胞计数（WBC，比值比[OR]1.619，95%置信区间[CI]1.172-2.237，P=0.005）、心源性休克（OR 47.706，95%CI 2.859-795.945，P=0.007）和左心室射血分数（LVEF，OR 0.803，95%CI 0.689-0.936，P=0.009）是院内早期死亡的独立危险因素。用于预测短期死亡风险的列线图显示出强大的辨别力，受试者操作特征曲线（AUC）下面积为0.956（95%CI 0.912-1.000）。
PIVSR的短期死亡率仍然很高。WBC、心源性休克和LVEF是短期死亡的独立预测因素。我们的列线图可能用于预测PIVSR患者的早期死亡率。
