Yang Na, Zhao Wenlong, Hao Yongchen, Liu Jun, Liu Jing, Zhao Xuedong, Yan Yan, Nie Shaoping, Gong Wei
Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
Intern Emerg Med. 2025 Jan;20(1):77-85. doi: 10.1007/s11739-024-03746-w. Epub 2024 Oct 27.
Cardiac rupture (CR) is fatal mechanical complication of ST-segment elevation myocardial infarction (STEMI). We systematically analyzed the clinical features of STEMI patients with CR, as well as predictors and treatments associated with risk of CR in contemporary era. In this nationwide database, 49,284 patients admitted within 48 h after STEMI were enrolled, and were stratified according to CR status. We analyzed patients' clinical characteristics, case fatality rate, and independent correlates of CR. A total of 188 (0.38%) patients had CR, of which 42.6% died during hospitalization. Older age, female gender, higher heart rate, history of diabetes, and worse cardiac function were risk factors of CR in patients with STEMI, while a previous history of myocardial infarction was associated with a reduced risk of CR. CR patients were less likely to undergo primary percutaneous coronary intervention (PCI). After adjustment, primary PCI was associated with 56% decreased risk of CR (OR 0.44, 95% CI 0.29-0.67). This result was consistent in the propensity-score matching analysis and inverse probability of treatment weighting analysis. CR was associated with high in-hospital mortality among STEMI patients. Multiple factors were associated with CR occurrence, primary PCI was associated with lower risk of CR, indicating that early intervention targeting the risk factors and implementation of primary PCI may improve its prognosis. Clinical trial registration ClinicalTrials.gov; Number: NCT02306616; URL: www.clinicaltrials.gov.
心脏破裂（CR）是ST段抬高型心肌梗死（STEMI）的致命机械性并发症。我们系统分析了STEMI合并CR患者的临床特征，以及当代与CR风险相关的预测因素和治疗方法。在这个全国性数据库中，纳入了49284例STEMI后48小时内入院的患者，并根据CR状态进行分层。我们分析了患者的临床特征、病死率以及CR的独立相关因素。共有188例（0.38%）患者发生CR，其中42.6%在住院期间死亡。年龄较大、女性、心率较高、糖尿病史以及心功能较差是STEMI患者发生CR的危险因素，而既往心肌梗死病史与CR风险降低相关。CR患者接受直接经皮冠状动脉介入治疗（PCI）的可能性较小。调整后，直接PCI与CR风险降低56%相关（OR 0.44，95%CI 0.29 - 0.67）。这一结果在倾向评分匹配分析和治疗权重逆概率分析中是一致的。CR与STEMI患者的高住院死亡率相关。多种因素与CR的发生相关，直接PCI与较低的CR风险相关，表明针对危险因素的早期干预和直接PCI的实施可能改善其预后。临床试验注册ClinicalTrials.gov；编号：NCT02306616；网址：www.clinicaltrials.gov。
