急性心肌梗死合并室间隔穿孔患者临床及冠脉造影特征和近期预后分析  

Clinical and Coronary Angiographic Features and Recent Prognosis Analysis of Patients with Acute Myocardial Infarction Complicating with Ventricular Septal Rupture

作　　者：郭超[1] 罗晓亮[1] 张峻[1] 袁建松[1] 李佳[1] 吴元[1] 乔树宾[1] GUO Chao;LUO Xiao-liang;ZHANG Jun;YUAN Jian-song;LI Jia;WU Yuan;QIAO Shu-bin(Coronary Heart Disease Center of Fuwai Hospital,National Center for Cardiovascular Disease,China Academy of Medical Science&Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院冠心病中心,北京市100037

出　　处：《中国分子心脏病学杂志》2021年第2期3816-3822,共7页Molecular Cardiology of China

摘　　要：目的探讨急性心肌梗死合并室间隔穿孔患者临床及冠脉造影特征,以及其对近期预后的影响因素。方法本研究采取回顾性分析,纳入2009年1月至2019年6月间收入我院接受冠脉造影的急性心肌梗死(AMI)合并室间隔穿孔(VSR)患者共64例,收集其临床表现、实验室检查、超声心动图检查、冠脉造影资料,并随访12个月全因病死率情况。结果共纳入AMI合并VSR患者64例,其中男性36例,女性28例,15例患者在12个月内死亡,病死率为23.44%;与存活组相比,死亡组患者外科术前肌酐增幅更高[85.00(52.00,173.80)μmol/L vs.27.00(1.50,67.00)μmol/L,P=0.001],血pH值更低(7.39±0.06 vs.7.44±0.06,P=0.028),心源性休克比例更高(60.0%vs.18.4%,P=0.002);两组患者VSR部位、左房前后径、左室舒张末径、左室射血分数、初始VSR直径、最大VSR直径、VSR直径变化等方面未见差异;冠脉造影方面,53例(82.81%)罪犯血管位于前降支,1例(1.56%)位于回旋支,10例(15.62%)位于右冠状动脉,22例(34.38%)为三支病变,48例(75.00%)罪犯病变位于罪犯血管的中段,31例(48.44%)罪犯血管为完全闭塞病变,冠脉解剖特征在存活组及死亡组未见差异;经多元回归分析,年龄(HR=1.088,95%CI:1.007-1.175,P=0.033)及合并心源性休克(HR=4.288,95%CI:1.463-12.568,P=0.008)是AMI合并VSR患者1年病死率的独立危险因素。结论对AMI合并VSR患者,超声及冠脉造影特征并不影响近期生存,年龄和心源性休克是1年病死率的独立危险因素。Objective To investigate clinical and coronary angiographic features of patients with acute myocardial infarction(AMI)complicating with ventricular septal rupture(VSR),and impact factors of recent mortality.Methods A total of 64 patients with post infarction VSR admitted in our hospital from January 2009 to June 2019 were included in this retrospective study,clinical manifestation,laboratory examination,coronary angiography and mortality of 12 months were collected.Results A total of 64 patients with AMI and VSR were enrolled,15 patients died within 12 months after diagnosis of VSR with a mortality of 23.44%.Compared with survivors,the non-survivors had a greater enhancement of creatinine[85.00(52.00,173.80)μmol/L vs.27.00(1.50,67.00)μmol/L,P=0.001],lower arterial pH(7.39±0.06 vs.7.44±0.06,P=0.028)and a higher incidence of cardiogenic shock(60.0%vs.18.4%,P=0.002).No significant differences observed between survivors and non-survivors in diameter of left atrium,left ventricle end-diastolic diameter,left ventricular ejection fraction,baseline VSR diameter,largest VSR diameter and the increase of VSR diameter.In coronary angiographic features,53 patients(82.81%)infarct related artery was LAD,1 patients(1.56%)for LCX and 10 patients(15.62%)for RCA,22 patients(34.38%)had three vessle disease,48 patients(75.00%)target lesions were in the middle segment of coronary artery,31 patients(48.44%)lesions were total occlusion,and no significant differences observed between the two groups.According to Cox regression analysis,higher age(HR=1.088,95%CI:1.007-1.175,P=0.033)and cardiogenic shock(HR=4.288,95%CI:1.463-12.568,P=0.008)before surgery were independent risk factors for 1 year mortality of VSR complicating AMI.Conclusion For patients with AMI complicating with VSR,features of ultrasonic cardiogram and coronary angiography show no impact on recent prognosis,but higher age and cardiogenic shock before surgery are independent risk factors for 1 year mortality.

关 键 词：急性心肌梗死 室间隔穿孔 冠脉造影 

分 类 号：R542.22[医药卫生—心血管疾病]