急性心肌梗死继发室间隔穿孔的临床结局与相关因素分析

钟扬; 陈菲菲; 赵谊昶

doi:10.13201/j.issn.1001-1439.2021.10.010

急性心肌梗死继发室间隔穿孔的临床结局与相关因素分析

- 1. 大连市第五人民医院心内科(辽宁大连,116021);
- 2. 大连医科大学附属第一医院心内科
基金项目:
国家自然科学基金(No:81700301)

辽宁省教育厅科学研究经费项目(No:LZ2020058)

详细信息

通讯作者: 赵谊昶,E-mail:474436988@qq.com

中图分类号: R542.2

收稿日期: 2021-04-17

修回日期: 2021-06-07

Clinical outcomes and related factors of ventricular septal rupture secondary to acute myocardial infarction

- 1. Department of Cardiology, The Fifth People's Hospital of Dalian, Liaoning, 116021, China;
- 2. Department of Cardiology, The First Affiliated Hospital of Dalian Medical University

More Information

Corresponding author: ZHAO Yichang, E-mail: 474436988@qq.com

Received Date: 17 April 2021

Revised Date: 07 June 2021

摘要

摘要: 目的:分析急性心肌梗死(AMI)后发生室间隔穿孔(PI-VSR)患者的临床资料,探讨PI-VSR 60 d内的临床结局及相关因素。方法:回顾性分析2003年10月1日-2021年2月28日收治于大连医科大学附属第一医院52例PI-VSR患者的临床资料,其中男性24例(46.15%),年龄(73.83±8.92)岁,AMI后至VSR发生的时间为(2.29±1.88) d,穿孔大小(8.58±4.25) mm。其中4例患者行外科修补,8例行介入封堵术。结果:PI-VSR后随访60 d,共有38例患者死亡,病死率为73.08%。与生存组相比,死亡组女性比例较高(65.79%∶28.57%,P=0.017)、年龄较大[(76.13±8.61)岁∶(67.57±6.61)岁,P=0.001]、行外科修补或介入封堵术比例少(18.42%∶50%,P=0.005)、室间隔缺损直径较大[(10.3±3.92) mm∶(6.82±2.14) mm,P=0.009]、B型利钠肽(BNP)较高[(2402.2±1679.23) pg/mL∶(1146.79±789.07) pg/mL,P=0.018]。室间隔缺损直径是PI-VSR死亡的独立预测因素(OR=1.727,P=0.013)。手术修复组冠状动脉开通率(58.33%∶25%,P=0.031)和生存率(58.33%∶17.5%,P=0.005)均高于未手术组。对8例行介入封堵治疗的患者进行分析,所有患者均成功封堵,其中3例患者在手术成功后15 d内死亡,死因分别为感染、溶血和肾功能衰竭;介入封堵后死亡组室间隔缺损直径显著大于生存组[(10.67±3.06) mm∶(5.4±1.52) mm,P=0.015],BNP[(1654.86±403.82) pg/mL∶(416.99±150.89) pg/mL,P=0.001]、总胆固醇[TC:(4.8±0.62) mmol/L∶(3.64±0.44) mmol/L,P=0.02]和低密度脂蛋白胆固醇[LDL-C:(2.86±0.48) mmol/L∶(1.97±0.43) mmol/L,P=0.035]显著高于生存组。结论:VSR为AMI的严重机械并发症,女性、高龄、未行修复术、室间隔缺损直径大、心功能恶化是死亡率增加的危险因素。
- 急性心肌梗死 /
- 室间隔穿孔 /
- 外科修补术 /
- 介入封堵术
Abstract: Objective: To analyze the clinical data of patients with ventricular septal rupture(VSR) secondary to acute myocardial infarction(AMI) and explore the clinical outcomes and the related factors within 60 days.Methods: Fifty-two patients who were diagnosed with PI-VSR admitted to the First Affiliated Hospital of Dalian Medical University from October 1, 2003 to February 28, 2021 were included. There were 24 males(46.15%), aged(73.83±8.92) years old, and the time from AMI to VSR was(2.29±1.88) days, the diameter of VSR was(8.58±4.25)mm. Surgical repair was performed in 4 patients, and interventional closure was performed in 8 patients.Results: After 60 days of follow-up, 38 patients died with a total mortality rate of 73.08%. Compared with the survival group, the death group had a higher proportion of women(65.79% vs. 28.57%, P=0.017), an older age([76.13±8.61]years vs. [67.57±6.61]years, P=0.001), and a lower proportion of underwent surgical repair or interventional occlusion(18.42% vs. 50%, P=0.005), a larger VSR diameter([10.3±3.92]mm vs. [6.82±2.14]mm, P=0.009), and higher B-type natriuretic peptide(BNP)([2402.2±1679.23]pg/mL vs. [1146.79±789.07]pg/mL, P=0.018). VSR diameter was an independent predictor of PI-VSR mortality(OR=1.727, P=0.013). The coronary opening rate(58.33% vs. 25%, P=0.031) and survival rate(58.33% vs. 17.5%, P=0.005) in the surgical repair group were higher than those in the non-surgical group. Eight patients who underwent interventional occlusion were successfully occluded, and 3 patients died within 15 days after successful operation. The causes of death were infection, hemolysis, and renal failure, respectively. VSR diameter in the death group was significantly larger than that in the survival group([10.67±3.06]mm vs. [5.4±1.52]mm, P=0.015); The levels of BNP([1654.86±403.82]pg/mL vs. [416.99±150.89]pg/mL, P=0.001), total cholesterol(TC, [4.8±0.62]mmol/L vs. [3.64±0.44]mmol/L, P=0.02), and low-density lipoprotein cholesterol(LDL-C, [2.86±0.48]mmol/L vs. [1.97±0.43]mmol/L, P=0.035) were significantly higher than those in the survival group.Conclusion: VSR is a serious mechanical complication of AMI. Female, advanced age, no repair treatment, a larger diameter of VSR, and cardiac dysfunction are risk factors for increased mortality.
- acute myocardial infarction /
- ventricular septal rupture /
- surgical repair /
- interventional occlusion

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