ABSTRACT
Objective:To investigate the cardiac presentations and the possible influencing factors of severe and critical coronavirus disease 2019 (COVID-19).Methods:A retrospective study was conducted. Patients with severe and critical COVID-19 admitted to the Eighth People's Hospital of Guangzhou from January 21st to February 24th 2020 were enrolled. According to the clinical classification, the patients were divided into severe group and critical group. The myocardial injury markers, such as lactate dehydrogenase (LDH), aspartate aminotransferase (AST), creatine kinase (CK), cardiac troponin I (cTnI), myoglobin (MYO), MB isoenzyme of creatine kinase (CK-MB), B-type natriuretic peptide (BNP) and electrocardiogram (ECG) changes were compared between the two groups.Results:A total of 55 COVID-19 patients were selected, including 15 critical cases and 40 severe cases. The patients with severe and critical COVID-19 were male-dominated (61.8%), the average age was (61.2±13.0) years old, 83.6% (46 cases) of them had contact history of Hubei, 38.2% (21 cases) of them were complicated with hypertension. There was no significant difference in baseline data between the critical group and the severe group. Myocardial injury markers of critical and severe COVID-19 patients were increased in different proportion, LDH increased in most patients (20 severe cases and 7 critical cases), followed by AST (16 severe cases and 5 critical cases). There was significant difference in the number of patients with elevated CK between severe group and critical group (cases: 1 vs. 4, P = 0.027). Abnormal ECG was found in 39 of 42 patients with ECG examination. Nonspecific change of T wave was the most common. Before and after treatment, 9 of 15 patients with changes of ECG and myocardial injury markers had oxygenation index less than 100 mmHg (1 mmHg = 0.133 kPa), and the prominent changes of ECG were heart rate increasing and ST-T change. Conclusions:The increase of myocardial injury markers and abnormal ECG were not specific to the myocardial injury of severe and critical COVID-19 patients. At the same time, the dynamic changes of myocardial injury markers and ECG could reflect the situation of myocardial damage.
ABSTRACT
Objective To investigate the clinical characteristics of patients with acute myocardial infarction (AMI) complicated with cardiac rupture (CR) and to explore the risk factors for the survival time of AMI combined with CR. Methods A retrospective study was conducted. The clinical data of 75 hospitalized patients with the confirmed diagnosis of AMI combined with free wall rupture (FWR) or ventricular septal rupture (VSR) admitted to Guangdong General Hospital from April 2009 to March 2015 were collected. They were divided into a survival < 30-day group (42 cases) and a survival ≥ 30-day (33 cases) group, and their clinical characteristics were analyzed. Receiver operating characteristic curve (ROC curve) was drawn, and the predictive value of each indicator for the patient's 30-day survival time was analyzed. Results The number of female patients (25 cases vs. 0 case) and the number of patients without diabetes (36 cases vs. 21 cases) in the survival < 30-day group were significantly higher than those in survival ≥ 30-day group (all P < 0.05). Therefore, both female and without diabetes were risk factors for the recent death of AMI complicated with CR. In the survival ≥ 30-day group, the number of patients with right coronary artery (RCA) lesions and immediately undergoing early percutaneous coronary intervention therapy (PCI) was significantly higher than that in survival < 30-day group (11 cases vs. 4 cases, P < 0.05). Therefore, the RCA lesion and immediately undergoing early PCI therapy was a recent survival protective factor. ROC curve analysis showed that AMI female and combined with diabetes and lesions in RCA had a certain predictive value for survival time of the patients, the area under ROC curve (AUC) and 95% confidence interval (95%CI) were 0.798 (0.696-0.899), 0.592 (0.542-0.743) and 0.647 (0.500-0.794) respectively, sensitivity and specificity were 34.6%, 16.1% and 42.3% and 12.9% respectively, all P < 0.05. Conclusions Women and without diabetes are the risk factors of recent death of AMI complicated by CR, and in patients with AMI complicated with CR and the involved lesion being RCA, PCI therapy should be performed as early as possible that may elevate the 30-day survival rate for the patients.
ABSTRACT
Objective To investigate the clinical characteristics of patients with acute myocardial infarction (AMI) complicated with cardiac rupture (CR) and to explore the risk factors for the survival time of AMI combined with CR. Methods A retrospective study was conducted. The clinical data of 75 hospitalized patients with the confirmed diagnosis of AMI combined with free wall rupture (FWR) or ventricular septal rupture (VSR) admitted to Guangdong General Hospital from April 2009 to March 2015 were collected. They were divided into a survival < 30-day group (42 cases) and a survival ≥ 30-day (33 cases) group, and their clinical characteristics were analyzed. Receiver operating characteristic curve (ROC curve) was drawn, and the predictive value of each indicator for the patient's 30-day survival time was analyzed. Results The number of female patients (25 cases vs. 0 case) and the number of patients without diabetes (36 cases vs. 21 cases) in the survival < 30-day group were significantly higher than those in survival ≥ 30-day group (all P < 0.05). Therefore, both female and without diabetes were risk factors for the recent death of AMI complicated with CR. In the survival ≥ 30-day group, the number of patients with right coronary artery (RCA) lesions and immediately undergoing early percutaneous coronary intervention therapy (PCI) was significantly higher than that in survival < 30-day group (11 cases vs. 4 cases, P < 0.05). Therefore, the RCA lesion and immediately undergoing early PCI therapy was a recent survival protective factor. ROC curve analysis showed that AMI female and combined with diabetes and lesions in RCA had a certain predictive value for survival time of the patients, the area under ROC curve (AUC) and 95% confidence interval (95%CI) were 0.798 (0.696-0.899), 0.592 (0.542-0.743) and 0.647 (0.500-0.794) respectively, sensitivity and specificity were 34.6%, 16.1% and 42.3% and 12.9% respectively, all P < 0.05. Conclusions Women and without diabetes are the risk factors of recent death of AMI complicated by CR, and in patients with AMI complicated with CR and the involved lesion being RCA, PCI therapy should be performed as early as possible that may elevate the 30-day survival rate for the patients.