Analysis of clinical characteristics and death causes in patients with acute myocardial infarction complicated by cardiac rupture / 中国综合临床

ABSTRACT

Objective To analyze death causes in patients with acute myocardial infarction complicated by cardiac rupture.Methods The patients who were admitted with cardiac rupture after acute myocardial infarction in Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2012 to December 2014 were enrolled.These patients were divided into death group and survival group.Then statistical analysis was performed for the clinical data of these patients in two groups,Logistic regression analysis was used to analyze the risk factors with statistical significance.Results A total of 59 patients diagnosed cardiac rupture after acute myocardial infarction were enrolled in this study,including 50 patients died,and 9 patients survived.There were significant differences between the two groups of patients with clinical baseline data.Compared with the survival group,death group had higher age ((69.94 ± 9.24) years old vs.(61.56 ± 9.14) years old,t =2.511,P =0.015),the higher incidence of malignant arrhythmia (22.0％ vs.0,x2 =4.070,P =0.044),the lower proportion of alcohol abuse (12.0％ vs.44.4％,x2 =5.704,P =0.017),higher fasting blood glucose ((8.97 ±3.98) mmol/L vs.(6.06± 1.25) mmol/L,t =4.153,P＜0.01) and triglycerides ((1.78±0.50) mmol/L vs.(1.39±0.20) mmol/L,t =4.146,P＜0.01),higher proportion of pulmonary arterial hypertension(22.0％ vs.0,x2 =4.070,P =0.044) and brain natriuretic peptide (406.50 (110.00,570.28) ng/L vs.33.00 (20.00,176.00) ng/L,P=0.004),smaller the left ventricular end diastolic diameter((47.76±5.13) mm vs.(52.22 ±4.66) mm,t =-2.434,P =0.018).The use of fondaparinux sodium (26.0％ vs.0,x2 =4.920,P =0.027),heparin (48.0％ vs.88.9％,x2 =5.138,P =0.023) and nitrates (72.0％ vs.100.0％,x2 =5.361,P =0.021)were significantly differences.The occurrence of acute heart failure in patients in death group was significantly higher than the survival group (11.0％ vs.0,x2 =3.258,P =0.071),but the difference was not significant.Logistic regression analysis showed that old age (OR =1.151),fasting blood glucose (OR =1.974)and heart rupture were significandy correlated (P＜ 0.05).Conclusion Cardiac rupture patients have a high mortality rate after myocardial infarction.Advanced age and fasting blood glucose were risk factors,while the use of common heparin is protective factor.Patients should be evaluated in a timely manner to assess the prognosis and to take targeted measures.