ABSTRACT
Objective To analyze the clinical features and prognosis of patients with acute myocardial infarction (AMI) complicated with different parts of heart rupture. Methods Patients diagnosed for AMI complicated with cardiac rupture from January 2010 to December 2015 in Beijing Anzhen Hospital were collected. All of them were divided into free wall rupture group and ventricular septal perforation group according to the rupture site. Clinical features, hospital related examination results, treatment and prognosis of these two groups were analyzed statistically. Results A total of 120 patients with AMI complicated with cardiac rupture were included in the study, including 64 patients with free wall rupture, and 56 patients with ventricular septal perforation. Compared with the ventricular septal perforation group by the single factor analysis, the patients in free wall rupture group had higher age (year: 68.88±9.31 vs. 63.86±8.68, t = 3.039, P = 0.003), lower body mass index [BMI (kg/m2): 22.74±2.07 vs. 25.21±2.99, t = -5.203, P = 0.000], higher rate of history of renal insufficiency (12.5% vs. 1.8%, χ2 = 4.942, P = 0.026), higher level of aspartate transaminase [AST (U/L): 76.00 (38.33, 197.50) vs. 33.50 (19.00, 137.50), Z = -2.788, P = 0.005], triglyceride [TG (mmol/L): 1.68±0.50 vs. 1.36±0.70, t = 2.903, P = 0.005], total cholesterol [TC (mmol/L): 4.21±0.74 vs. 3.87±1.01, t = 2.081, P = 0.040], high density lipoprotein cholesterol [HDL-C (mmol/L): 1.12±0.91 vs. 0.91±0.32, t = 2.910, P = 0.004] and cardiac troponin I [cTnI (μg/L): 18.83 (4.48, 81.68) vs. 0.82 (0.08, 8.50), Z =-5.011, P = 0.000], lower level of blood urea nitrogen [BUN (mmol/L): 7.11±3.11 vs. 10.14±6.97, t = -2.999, P = 0.004], brain natriuretic peptide [BNP (ng/L): 169.00 (98.50, 485.75) vs. 793.00 (478.75, 1 426.25), Z = -5.739, P = 0.000], and D-dimer [μg/L: 219.00 (141.00, 315.75) vs. 310.50 (188.75, 532.00), Z = -2.607, P = 0.009], smaller left ventricular end diastolic diameter [LVEDD (mm): 48.58±5.17 vs. 53.65±6.63, t = -4.631, P = 0.000] and left ventricular end systolic diameter [LVESD (mm): 33.54±5.40 vs. 37.24±6.53, t = -3.397, P = 0.001], lower proportion of left ventricular aneurysm formation [14.1% (9/64) vs. 76.8% (43/56), χ2 = 47.851, P = 0.000] and pulmonary arterial hypertension [20.3% (13/64) vs. 53.6% (30/56), χ2 = 14.368, P = 0.000], higher usage rate of aspirin [100% (64/64) vs. 75.0% (42/56), χ2 = 18.113, P = 0.000], clopidogrel usage rate [82.8% (53/6) vs. 46.4% (26/56), χ2 = 17.578, P = 0.000], ticagrelor usage rate [12.5% (8/64) vs. 1.8% (1/56), χ2 = 4.924, P = 0.026], and common heparin usage rate [53.1% (34/64) vs. 10.7% (6/56), χ2 = 24.174, P = 0.000], lower usage rate of nitrates [70.3% (45/64) vs. 85.7% (48/56), χ2 = 4.063, P = 0.044], higher percutaneous coronary intervention (PCI) operation rate [42.9% (27/64) vs. 12.5% (7/56), χ2 = 13.388, P = 0.000], lower coronary artery bypass graft (CABG) surgery rate [7.8% (5/64) vs. 48.2% (27/56), χ2 = 24.930, P = 0.000], success rate of CABG surgery [60.0% (3/5) vs. 100% (27/27), χ2 = 8.233, P = 0.004], and incidence rate of cerebral infarction in hospital [1.6% (1/64) vs. 10.7% (6/56), χ2 = 4.554, P = 0.033], higher hospital all-cause mortality [85.9% (55/64) vs. 23.2% (13/56), χ2 = 47.851, P = 0.000]. The differences of other indicators were not statistically sig nificant. Conclusions Patients with AMI complicated with free wall rupture usually have more risk factors and worse prognosis. These two types of patients should be treated with target.
ABSTRACT
Objective: To evaluate clinical features with in-hospital and long-term prognosis of acute myocardial infarction (AMI) in patients ≤40 years of age by different genders and to analyze the predictors for major adverse cardiovascular event (MACE) occurrence. Methods: A total of 685 AMI patients ≤40 years treated in our hospital from 2012-01-01 to 2015-08-31 were consecutively enrolled. The patients were divided into 2 groups by gender: Male group,n=650 and Female group,n=35. The baseline data, clinical features, in-hospital MACE incidence were collected by telephone communication and compared between 2 groups; the long-term risk factors for MACE occurrence were analyzed. Results: The AMI ratio in male patients was 94.89%, in female was 5.11% and the onset age in Male group was higher than Female group (35.53±4.21) years vs (34.05±4.98) years,P=0.046. Compared with Female group, Male group showed the lower rates of coronary left main diseases (3.2% vs 11.4%,P=0.012) and in-hospital heart failure (8.3% vs 25.7%,P=0.001). The median follow-up time was of 727.0 (411.5, 1102.0) days and during that period, MACE occurrence rates in Male group was 46 (7.1%) cases and in Female group was 2 (5.7%) cases,P=0.758. Increased level of hs-TnI, (OR=1.003, 95% CI 1.001-1.006,P=0.020) and multi coronary artery disease (OR=1.964, 95% CI 1.018-3.790,P=0.044) were the independent predictors for long- term adverse event occurrence; while PCI (OR=0.475, 95% CI 0.241-0.936,P=0.031) was the protector for long-term prognosis in young male AMI patients. Conclusion: AMI patients≤40 years were mainly in male gender, the mean onset age in male was elder than female. Increased hs-TnI level and multi coronary artery disease were the predictors for MACE occurrence, while PCI was the protective factor for long-term prognosis in young male AMI patients.