急性心肌梗死对应导联ST段变化与冠状动脉病变的关系

目的 用冠状动脉造影技术研究急性心肌梗死(AMI)对应导联ST段变化与冠状动脉病变的关系。方法136例急性心肌梗死共分五组:①组,前壁梗死(V1-6)伴有Ⅱ,Ⅲ,aVF导联ST段下移。②组,下壁梗死(Ⅱ,Ⅲ,aVF)同时伴有V1-6导联ST段下移。③组,下壁梗死(Ⅱ,Ⅲ,aVF)同时伴有I,aVL导联ST段下移。④组,前壁梗死(V1-6)未伴有其它导联的ST段变化。⑤组,下壁梗死(Ⅱ,Ⅲ,aVF)未伴有其它导联的ST段变化。所有患者均进行冠状动脉造影。结果 前壁心肌梗死伴有Ⅱ,Ⅲ,aVF导联ST段下移25例中有88%为左冠状动脉前降支病变,其中90.9%为左冠状动脉近端病变。前壁心肌梗死未伴有Ⅱ,Ⅲ,aVF导联ST段下移的36例患者中有94.4%为左冠状动脉前降支病变,两者统计无显著性差异。在下壁心肌梗死伴有V1-6导联ST段下移组22例中有81.8%为右冠状动脉病变,但同时伴有前降支病变的却有77.3%,其中单支病变仅18.2%。下壁心肌梗死未伴有V1-6导联ST段下移34例有91.2%为右冠状动脉病变,但同时伴有前降支病变的仅有32.4%,其中单支病变达52.9%。两组统计分别为P<0.001和P相似文献   

Effects of isosorbide dinitrates intravenously in high doses over a short period in anterior acute myocardial infarction

The effects of intravenous isosorbide dinitrate administered in high doses over a short period of time in 17 patients (14 men, 3 women, mean age 67 years) with anterior wall acute myocardial infarction were evaluated. Patients were classified into 2 groups based on the electrocardiographic pattern of acute ischemia. Patients presented with anterior acute myocardial infarction; an electrocardiographic pattern of third-degree ischemia demonstrated a more favorable electrocardiographic and radionuclear angiographic evolution than similar patients who presented with an electrocardiographic pattern of second-degree ischemia.     

二硫代氨基甲酸吡咯烷对大鼠心肌梗死后心肌细胞肥大的影响

目的:探讨二硫代氨基甲酸吡咯烷(PDTC)对大鼠心肌梗死后心肌细胞肥大的影响及机制。方法:制作大鼠心肌梗死模型,随机分为PDTC干预(PD)组和心肌梗死对照(MI)组,另设假手术(SH)组,每组大鼠6只。PD组于术后24h腹腔注射PDTC(80 mg.kg-1.d-1),MI组及SH组注射0.9%氯化钠液对照。连续给药28 d后处死动物,计算心肌细胞面积、周长、平均直径。RT-PCR和免疫组化分别检测核转录因子-κBp65(NF-κBp65)及白介素-1β(IL-1β)的mRNA和蛋白质表达量。结果:与SH组比较,PD组和MI组的心肌细胞的直径、周长和表面积明显增大,NF-κBp65和IL-1β的mRNA及蛋白质表达量明显增加,差异均有统计学意义(P<0.01)。与MI组比较,PD组的心肌细胞的直径、周长和表面积改变明显减轻,NF-κBp65和IL-1β的mRNA及蛋白质表达量明显降低,差异有统计学意义(P<0.01)。结论:PDTC能一定程度地改善大鼠心肌梗死后心肌细胞肥大,其机制可能与抑制NF-κB激活,下调炎性细胞因子如IL-1β表达有关。     

Stress hyperglycaemia is an independent predictor of left ventricular remodelling after first anterior myocardial infarction in non-diabetic patients.

AIMS: Stress hyperglycaemia (SH) is associated with adverse outcome in patients with acute myocardial infarction (MI) but the mechanisms underlying this association are unknown. Our hypothesis was that SH on admission for acute MI may be associated with left ventricular (LV) remodelling. METHODS AND RESULTS: We analysed LV remodelling in 162 non-diabetic patients with anterior MI. SH was defined as a glycaemia on admission >or=7 mmol/L. Systematic echocardiographic follow-up was performed at 3 months and 1 year after MI. The changes in end-diastolic volume (EDV) and end-systolic volume (ESV) from baseline to 1 year were 11.4 +/- 16.5 and 6.4 +/- 12.4 ml/m(2), respectively, in patients with SH vs. 1.9 +/- 11.1 and 0.2 +/- 8.5 ml/m(2), respectively, in patients without SH (both P < 0.0001). When LV remodelling was defined as a >20% increase in EDV, it was observed in 46% patients in the SH group vs. 19% patients in the no SH group (P = 0.0008). By multivariable analysis, baseline wall motion score index (P = 0.001) and SH (P = 0.009) were independently associated with changes in EDV. SH was an independent predictor of LV remodelling [adjusted OR: 3.22 (1.31-7.94)]. CONCLUSION: SH is a major and independent predictor of LV remodelling after anterior MI in non-diabetic patients.     

重组人脑利钠肽在前壁心梗合并心衰患者中疗效观察

目的 观察急性前壁心梗合并心衰患者使用重组人脑利钠肽的疗效.方法 选取2017年1月-2019年12月就诊于毕节市第一人民医院心血管内科的急性前壁心梗合并心衰患者,按患者行急诊PCI术后是否应用重组人脑利钠肽分为治疗组和对照组.分析比较两组患者的NT-proBNP和左心功能.结果 治疗组术后72小时血浆NT-proBNP浓度显著低于对照组;左室舒张末内径、左室舒张末内径、左室射血分数未观察到明显改善.结论 对急性前壁心肌梗死患者行急诊冠脉介入治疗后加用rhBNP,可快速缓解心衰症状,改善心功能.     

Q-T interval changes in acute transmural myocardial infarction

The serial Q-T interval changes were studied in 29 survivors of acute transmural anteroseptal (11 patients), extensive anterior (10 patients), and inferior (8 patients) myocardial infarctions admitted 4 to 48 hours after the acute episode. Q-T prolongation evidenced by abnormal Q-T ratio was a constant and almost universal feature detected in 28 (97.06%) patients. The maximum Q-T prolongation was observed on an average about 36 hours after the onset of acute episode. Patients with anterior myocardial infarction had significantly higher Q-T ratios than inferior myocardial infarction group. There was a rapid decline towards normal in anteroseptal and inferior myocardial infarction groups in which it settled during initial six days, whereas, in extensive anterior myocardial infarction group, it took a longer time beyond six days to settle. The normalization of Q-T interval did not correspond to settling down of the elevated ST segment. Patients having ventricular tachyarrhythmias (VT and frequent VPBS) (14) had significantly higher Q-T ratios than those without arrhythmias. Further, the Q-T ratio was significantly higher in patients with VT (4) than in those with frequent VPBs (10). Alterations in Q-T ratio were not related to severity or extent of infarction and occurrence of heart failure. It is concluded that prolongation of electrical systole (Q-T interval) is a constant phenomenon after acute transmural myocardial infarction, magnitude and time course of its alterations being related to location of infarct and its electrical complications. It does not seem to have any correlation with mechanical complications of infarction.(ABSTRACT TRUNCATED AT 250 WORDS)     

Gastric emptying of liquids in rats submitted to acute myocardial infarction

Gastric Emptying (GE) is food transition from the stomach to the upper small intestine. Haemodynamics changes modify gastric emptying and the gastroduodenal motor activity. Myocardial Infarction is a pathological condition in which there are haemodynamics changes. Therefore, the objective of the present investigation was to study the effect of acute myocardial infarction on rat gastric emptying of an isosmotic and inert liquid meal. We conducted a study involving male Wistar rats (varying in body weight from 220 g to 250 g), that were allowed to habituate in a laboratory environment and then divided into 3 groups: group INF, rats in which the myocardial infarction was produced by left anterior coronary artery ligation; group SH, rats in which the myocardial infarction was simulated without ligating the anterior coronary artery; and group NA, rats which were not given any anesthesia or surgical procedures. After group constitution, animals were fasted with access to water ad libitum. 24 hours later, the Gastric Retention (GR) of 1.5 ml/100 g animal weight of a test meal of 0.9% NaCl plus the marker phenol red was evaluated. GE was indirectly evaluated in conscious animals, through determining the percentage of gastric retention (% GR) of a test meal, measured 10 minutes after orogastric infusion. Results of the present study showed that animals from the INF group presented GR (median=48.0%), significantly higher than the NA group (30.6%) and SH group (36.6%). No statistical difference in GR was observed between the SH and NA groups. Infarcted area, expressed in percentages, in animals of the INF group was 51.3+/-4.7% (mean SEM, N=17) which not presented correlation with results of GR of the same group (r=-0.05). From a caloric viewpoint, the results suggested that acute myocardial infarct in rats induce delay of the gastric emptying of an isosmotic and inert liquid meal.     

Prophylactic intraaortic balloon pumping preserves left ventricular systolic function in acute anterior myocardial infarction without cardiogenic shock

OBJECTIVES: Left ventricular function and prognosis were evaluated in patients with acute myocardial infarction who underwent primary percutaneous coronary intervention supported by intraaortic balloon pumping. METHODS: Fifty-eight consecutive patients with first acute myocardial infarction were treated between July 1999 and April 2006. Twenty-five had cardiogenic shock on admission, whereas 33 did not. Patients with anterior acute myocardial infarction without cardiogenic shock were divided into the prophylactic intraaortic balloon pumping group (Group 1; n=17) and the rescue intraaortic balloon pumping group (Group 2; n=9). RESULTS: Thirty-day in-hospital mortality was 52% in cardiogenic shock patients, and 3% in non-shock patients. Baseline characteristics of non-shock anterior acute myocardial infarction were similar including Thrombolysis in Myocardial Infarction (TIMI) risk scores (5.1 and 5.0) in the two groups. However, average left ventricular ejection fraction in the convalescent stage was superior in Group 1 (48.7% vs. 37.8%, p = 0.03). Thirty-day in-hospital mortality was 0% in Group 1 and 11% in Group 2 (p = 0.34). Cox's hazard ratio in Group 2 to Group 1 was 2.38 (95% confidence intrerval; 0.84-11.1, p = 0.09) in terms of the subsequent major cardiac events. CONCLUSIONS: Prophylactic use of intraaortic balloon pumping starting prior to primary percutaneous coronary intervention preserves the convalescent left ventricular systolic function in patients with high risk for anticipated cardiac events after anterior acute myocardial infarction without cardiogenic shock.     

Permanent pacing in patients with transient trifascicular block during acute myocardial infarction

Patients with acute myocardial infarction and transient complete atrioventricular (A-V) block in association with right bundle branch block and left anterior hemiblock have a high incidence rate of late sudden death presumably due to recurrent A-V block. Over a 5 year period, 18 patients demonstrated right bundle branch block and left anterior hemiblock and had transient complete block during an acute myocardial infarction and survived to hospital discharge. Of six patients who did not have permanent pacing, five died suddenly (one was lost to follow-up) with a mean survival time of 2.4 months after hospital discharge. Twelve subsequent patients received permanent demand pacemakers and had a significantly improved prognosis with a mean survival time of 18 months (P < 0.001). Six patients were still alive at an average follow-up time of 20 months. Prophylactic permanent pacing significantly improves the prognosis after acute myocardial infarction in this select subgroup of patients.     

Importance of reciprocal ST segment depression in leads V5 and V6 as an indicator of disease of the left anterior descending coronary artery in acute inferior wall myocardial infarction.

The purpose of this study was to determine the coronary angiographic correlations (specifically disease of the left anterior descending coronary artery) of reciprocal ST segment depression appearing during inferior acute myocardial infarction. Forty six patients (41 men and five women; mean age 56 years) were allocated into two groups based on the extent of precordial ST segment depression: widespread (V1-V6) ST depression v localised (V1-V4) ST depression. Patients with no reciprocal ST depression or patients with ST depression in V1-V4 but with ST elevation in V5 and V6 (inferolateral acute myocardial infarction) were excluded. All patients were catheterised during hospital admission for infarction. Twenty four of the 28 patients with ST depression in V1-V6 had significant lesions in the left anterior descending coronary artery whereas 16 of the 18 patients with ST depression in V1-V4 had insignificant or no lesions in the left anterior descending artery. The sensitivity, specificity, and positive and negative predictive values of widespread ST depression in predicting disease in the left anterior descending coronary artery were 92%, 80%, and 86% and 89% respectively. In patients with inferior acute myocardial infarction and precordial ST depression, the extent of ST depression is of clinical significance. Widespread (V1-V6) ST depression suggests disease of the left anterior descending coronary artery, whereas localised ST depression (V1-V4) indicates its absence.     

Spontaneous changes in regional wall motion abnormalities in acute myocardial infarction

The incidence of improvement in regional wall motion of segments with severe contractile abnormalities in the first 10 days after a first acute myocardial infarction (AMI) was assessed with serial gated blood pool scans in 95 patients who received standard medical therapy. Regional wall motion was quantitatively assessed as percent chord shortening in 4 segments in the anterior view and 4 segments in the 45 degree left anterior oblique view. Among 237 segments with no more than 15% shortening (severely hypokinetic or akinetic [SH/A] segments), 59 (25%) improved at least 15% at 10 days, 166 (70%) did not change and 12 (5%) deteriorated by at least 15%. Among 91 patients who had SH/A segments, 37 (41%) had improvement in at least 1 SH/A segment (group 1) and 54 had no improvement in SH/A segments (group 2). Group 1 had a higher initial ejection fraction (EF) (50 +/- 12%) than group 2 (45 +/- 13%, p less than 0.05). The changes in percent shortening of SH/A segments were compared with coronary anatomy in 37 patients who underwent coronary angiography. The 17 patients with 1-vessel coronary artery disease (CAD) had significantly improved wall motion (8.2 +/- 13.4%, p less than 0.005), in contrast to the 20 patients with multivessel CAD (1.8 +/- 11.5%, difference not significant). Among patients with 1-vessel CAD, the improvement was greater in patients with right coronary or left circumflex artery disease (12.8 +/- 14.4%) than in those with left anterior descending disease (4.1 +/- 13.4%, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Myocardial sulfhydryl pool alterations occur during reperfusion after brief and prolonged myocardial ischemia in vivo

Myocardial sulfhydryl (SH)-containing compounds, including reduced glutathione (GSH), are both defenses against and potential markers of reactive oxygen metabolite injury during ischemia and reperfusion. We examined the alterations in GSH and other myocardial SH pools during reperfusion in anesthetized dogs exposed to brief (15 minutes, n = 7) or prolonged (90 minutes, n = 6) regional ischemia caused by occlusion of the left anterior descending artery. Ninety minutes of ischemia followed by 5 hours of reperfusion, which resulted in myocardial necrosis of 43.9 +/- 4.0% of the area at risk, caused a 22% reduction in total myocardial SH groups (p less than 0.01), a 57% decrease in nonprotein myocardial SH groups (p less than 0.01), a 56% decrease in GSH (p less than 0.01), and a 62% decrease in non-GSH, nonprotein SH groups (p less than 0.02). However, protein SH groups were not significantly reduced (12% decrease, p = NS). Also, myocardial release of GSH and oxidized glutathione (GSSG) into the coronary venous effluent occurred during early reperfusion. In contrast, 15 minutes of ischemia, followed by 30 minutes of reperfusion, did not alter myocardial total SH groups, protein SH groups, or GSH (9% decrease, p = NS); nor was there reperfusion release of GSH or GSSG. However, even with brief ischemia, nonprotein SH groups decreased 23% (p less than 0.05), due mainly to a 59% decrease in the non-GSH, nonprotein SH pool (p less than 0.05). These changes after brief ischemia occurred without alterations in myocardial GSSG or the GSH/GSSG ratio.(ABSTRACT TRUNCATED AT 250 WORDS)     

Importance of reciprocal ST segment depression in leads V5 and V6 as an indicator of disease of the left anterior descending coronary artery in acute inferior wall myocardial infarction

The purpose of this study was to determine the coronary angiographic correlations (specifically disease of the left anterior descending coronary artery) of reciprocal ST segment depression appearing during inferior acute myocardial infarction. Forty six patients (41 men and five women; mean age 56 years) were allocated into two groups based on the extent of precordial ST segment depression: widespread (V1-V6) ST depression v localised (V1-V4) ST depression. Patients with no reciprocal ST depression or patients with ST depression in V1-V4 but with ST elevation in V5 and V6 (inferolateral acute myocardial infarction) were excluded. All patients were catheterised during hospital admission for infarction. Twenty four of the 28 patients with ST depression in V1-V6 had significant lesions in the left anterior descending coronary artery whereas 16 of the 18 patients with ST depression in V1-V4 had insignificant or no lesions in the left anterior descending artery. The sensitivity, specificity, and positive and negative predictive values of widespread ST depression in predicting disease in the left anterior descending coronary artery were 92%, 80%, and 86% and 89% respectively. In patients with inferior acute myocardial infarction and precordial ST depression, the extent of ST depression is of clinical significance. Widespread (V1-V6) ST depression suggests disease of the left anterior descending coronary artery, whereas localised ST depression (V1-V4) indicates its absence.     

急性前壁心肌梗死早期 T波倒置程度的 临床意义

目的　探讨心肌梗死早期心电图中最大倒置T波(maximalnegativeTwave;NTmax)的临床意义。方法　以初发急性前壁心肌梗死(AMI)10h以内来院就诊的80例患者作为对象。根据NTmax深度分为三组(1)深倒置T波(DNT)组NTmax≥10mm；(2)中度倒置T波(INT)组4mm≥NTmax＜10mm；(3)浅倒置T波(SNT)组NTmax＜4mm。根据铊201心肌同位素显像和锝99心室腔同位素造影分别求出心肌灌注指数和左室射血分数(LVEF)，将肌酸激酶最高值(CKmax)、心肌灌注指数和LVEF作为判断心肌梗死严重程度的指标，分析了NTmax与心肌梗死面积、左室功能状况的关系。结果　NTmax出现在发病后4～102(47.2±21.4)h,NTmax与CKmax呈逆相关(r=0.416,P＜0.005)，与左室射血分数(r=0.564,P＜0.003)呈正相关。DNT组与其他二组比较,V     

急性心肌梗死合并胸腔积液60例分析

目的通过分析急性心肌梗死（AMI）合并胸腔积液的临床特点、治疗方法和预后，探讨急性心肌梗死合并胸腔积液的一般规律。方法分析急性心肌梗死患者130例的临床资料，选择60例急性心肌梗死合并胸腔积液患者，70例无胸腔积液的急性心肌梗死为对照，分析两种患者的临床特点、冠状动脉病变情况，以及治疗方法和预后等。结果急性前壁心肌梗死容易合并胸腔积液，与梗死面积有关，肌钙蛋白水平越高，发生胸腔积液的概率越大，利尿剂应用延迟也易发生胸腔积液。及时行胸腔引流、应用无创呼吸机及输注白蛋白可有效缓解呼吸困难，缩短住院时间，降低死亡率。结论急性心肌梗死合并中到大量胸腔积液并不少见，发病机制可能与梗死面积较大、利尿剂使用延迟等有关，及时发现并有效处理，可改善预后。     

Initial presenting electrocardiogram as determinant for hospital admission in patients presenting to the emergency department with chest pain: a pilot investigation

BACKGROUND: Evaluation of chest pain accounts for millions of costly Emergency Department (ED) visits and hospital admissions annually. Of these, approximately 10-20% are myocardial infarctions (MI). HYPOTHESIS: Patients with chest pain whose initial electrocardiogram (ECG) is normal do not require hospital admission for evaluation and management of a possible myocardial infarction. METHODS: The medical records of a consecutive cohort of 250 patients who presented to the ED with chest pain and were admitted by the ED physician to a cardiology inpatient service of an academic tertiary care medical center were reviewed. Reasons for admission to hospital was to rule out an acute coronary syndrome, specifically, myocardial infarction. The initial ECG of each patient was evaluated for abnormalities and compared with the final diagnosis. RESULTS: Of the 75 patients presenting with normal ECGs (normal, upright T waves and isoelectric ST segments), 1 (1.3%) was subsequently diagnosed with a myocardial infarction by Troponin I elevation alone. Of the 55 patients presenting with abnormal ECGs but no clear evidence of ischemia [i.e., left bundle branch block (LBBB), right bundle branch block (RBBB), left anterior hemiblock (LAH)], 2 (3.6%) were diagnosed with MI. Of the 48 patients presenting with abnormal ECGs questionable for ischemia (nonspecific ST and T wave changes that were not clearly ST segment elevation or depression), 7 (14.6%) were diagnosed with an MI. Of the 72 patients who presented with abnormal ECGs showing ischemia (acute ST segment elevation and/or depression), 39 (54.2%) were shown to have evidence for MI. SUMMARY: Patients who presented with normal ECGs (category 1) were extremely low risk for acute myocardial infarction. Patients with abnormal ECGs but no evidence of definite ischemia (category 2) had a relatively low incidence of MI. Patients with abnormal ECGs questionable for ischemia (category 3) had an intermediate risk of acute myocardial infarction. The majority of patients with abnormal ECGs demonstrating ischemia (category 4) were subsequently shown to evolve an acute myocardial infarction. CONCLUSIONS: Patients with chest pain and initial ECGs with ST segment abnormalities suggestive or diagnostic for ischemia, should be admitted to the hospital for further evaluation and management. Patients with ECGs that do not display acute ST segment changes are at a lower risk for acute myocardial infarction than those with acute ST segment changes and should be admitted on the basis of cardiac risk profile. (i.e., age, gender, hypertension, diabetes, smoking, known coronary artery disease, etc.) Patients with normal ECGs (category 1) are at extremely low risk, and it may be acceptable to consider further evaluation on an outpatient basis.     

Role of echocardiography in the assessment of left ventricular thrombus embolic potential after anterior acute myocardial infarction

The contribution of cardiac ultrasound in assessment of the embolic potential of left ventricular thrombi after anterior acute myocardial infarction was verified in a prospective study of serial echocardiograms (mean, 18.9 examinations per patient) obtained over a long-term period (1-72 months; mean, 38±12). The study population comprised 222 patients (162 men; age, 64±11 years) with a first anterior acute myocardial infarction, treated with thrombolysis (group A) or receiving no antithrombolic therapy (group B). Embolism occurred in a total of 12 patients (11 with a left ventricular thrombus; p<0.005) and was more frequent in group B (10 patients; p<0.04). Predictors of embolism were the absence of thrombolysis, detection of a left ventricular thrombus, protrusion or mobility of the thrombus, and morphologic changes in the thrombus over time. Patients in group A had a lower incidence of each of these predictors, and a higher thrombus resolution rate. An appropriate echocardiographic protocol is crucial to assessment of the embolic potential of left ventricular thrombi after anterior acute myocardial infarction and may help to identify candidates for aggressive antithrombotic therapy (c)2001 CHF, Inc.     

ANTERIOR ST SEGMENT DEPRESSION IN INFERIOR MYOCARDIAL INFARCTION: EFFECT ON COMPLICATIONS AND LONG-TERM SURVIVAL

Abstract The effect of anterior ST segment depression in inferior myocardial infarction on early complications and long-term prognosis was studied. A modification of the Minnesota Code was used for grading the extent of ST segment depression in leads V₂ to V₄ on the first hospital electrocardiogram. In 267 patients with acute inferior myocardial infarction, 107 had isoelectric anterior ST segments, 84 had minor ( 0.5 mm) depression, and 76 had major (> 0.5 mm) depression. Patients with anterior ST segment depression had higher serum enzyme levels, higher Norris coronary pronostic indices, and more frequent cardiac failure during the acute stages, but similar 28 day case fatality rate (11.1%) compared with patients without anterior ST segment depression (12.6%). In the subsequent four years total cardiac death rates were not significantly different and the pattern of survival was not influenced, but there was a higher fatal re-infarction rate in patients with major anterior ST segment depression. Thus, anterior ST segment depression in inferior myocardial infarction was associated with more severe infarction in the early phase but was not a reliable marker of high risk after recovery. Selection of patients for further investigation should not be based on this observation alone.     

Impact of renal dysfunction and glucometabolic status on one month mortality after acute myocardial infarction

Patients with impaired glucometabolic status or renal function have a higher mortality after acute myocardial infarction. It is unclear whether this higher risk is independent or related to the quality of care. In a prospective registry, stress hyperglycaemia (SH) was defined as glucose level>140 mg/dl. Renal function was assessed by the glomerular filtration rate (GFR): normal (>/=60), mild (30-60) and severe dysfunction (<30 ml/min/1.72 m(2)). The level of risk was assessed by the TIMI risk index and the quality of care by the rate of use of five guidelines-recommended treatments. Among the 1388 patients included, 23% had diabetes, 16% had SH, renal function was normal in 55%, mildly impaired in 35% and severely impaired in 9.5%. At one month, the mortality rate was higher in patients with SH (18%) as compared with diabetics (9%) or those with normal glucometabolic status (5%). Similarly, the mortality rate was higher in those with impaired renal function. Multivariable analysis identified SH, GFR group, TIMI risk index, ST segment elevation MI and quality of care as independent predictors of one-month mortality. In patients with acute MI, SH and GFR<30 ml/min/m(2) are independent predictors of mortality after adjustment for the level of risk and acute care.     

急性心肌梗死后左心室游离壁破裂患者临床特点分析

目的探讨急性心肌梗死(acute myocardial infarction,AMI)后发生左心室游离壁破裂(free wall rupture,FWR)患者的临床特点及危险因素。方法入选2010年12月至2018年12月南京医科大学附属南京医院明确诊断为AMI的患者4221例,其中发生FWR的患者81例(FWR组),按照1:5匹配原则,随机选取未发生心脏破裂(且未发生室间隔穿孔)的患者405例作为非FWR组,比较两组患者临床基线资料及预后。结果(1)AMI患者中出现FWR的风险为1.9%。(2)与非FWR组相比,FWR组患者年龄偏大,前壁心肌梗死较多,心功能更差,接受手术治疗(包括经皮支架植入和冠状动脉旁路移植术)的患者比例偏低,且所有患者均出现院内死亡。(3)91.4%的患者FWR发生在AMI起病1周之内,其中24 h内发生FWR 37例(45.7%)。(4)COX回归分析发现,年龄(HR=1.055,95%CI:1.032~1.078,P<0.001)、急性前壁心肌梗死(HR=1.907,95%CI:1.211~3.002,P=0.005)和手术治疗(HR=0.126,95%CI:0.072~0.220,P<0.001)是AMI患者出现FWR的独立预测因子。结论AMI患者发生FWR的风险约为1.9%,而且通常发生在心肌梗死1周内,高龄和急性前壁心肌梗死患者容易发生FWR,而手术治疗能明显降低FWR风险。