Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: A report from the SHOCK Trial Registry
Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: A report from the SHOCK Trial Registry
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DOI：
10.1016/s0735-1097(00)00878-0
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发表时间：
2000-09-01
影响因子：
24
通讯作者：
Hochman, JS
中科院分区：
文献类型：
--
作者：
Menon, V;Webb, JG;Hochman, JS
目的 我们希望评估心源性休克 (CS) 并发急性心肌梗死 (MI) 情况下室间隔破裂 (VSR) 患者的概况和结果。 背景 心源性休克常见于 VSR 并发急性 MI。尽管进行了手术治疗，此类患者的死亡率仍然很高。 方法 我们分析了参加急性梗死 CS SHOCK 试验注册的 939 名患者，将休克与 VSR 相关的 55 名患者与 884 名主要左心室衰竭患者进行比较。 结果 破裂发生在梗死后中位 16 小时。患有 VSR 的患者往往年龄较大 (p = 0.053)，女性较多 (p = 0.002)，且较少有既往梗塞 (p < 0.001)、糖尿病 (p = 0.015) 或吸烟史 (p = 0.033)。他们还更频繁地接受右心导管插入术、主动脉内球囊反搏术和搭桥手术。尽管破裂患者的冠状动脉疾病较轻，但其院内死亡率较高（87% vs. 61%，p < 0.001）。 31 例破裂患者接受了手术修复（其中 21 例同时进行了搭桥手术）； 6 人（19%）幸存。在 24 名接受药物治疗的患者中，只有 1 名幸存。 结论 当 VSR 导致 CS 时，院内死亡率很高。室间隔破裂可能在梗死后早期发生，女性和老年人可能更容易发生。尽管预后较差，但手术仍然是这种情况下的最佳治疗选择（J Am Coll Cardiol 2000；36：1110-6）（C）2000，美国心脏病学会。
OBJECTIVES We wished to assess the profile and outcomes of patients with ventricular septal rupture (VSR) in the setting of cardiogenic shock (CS) complicating acute myocardial infarction (MI).BACKGROUND Cardiogenic shock is often seen with VSR complicating acute MI. Despite surgical therapy, mortality in such patients is high.METHODS We analyzed 939 patients enrolled in the SHOCK Trial Registry of CS in acute infarction, comparing 55 patients whose shock was associated with VSR with 884 patients who had predominant left ventricular failure.RESULTS Rupture occurred a median 16 h after infarction. Patients with VSR tended to be older (p = 0.053), were more often female (p = 0.002) and less often had previous infarction (p < 0.001), diabetes mellitus (p = 0.015) or smoking history (p = 0.033). They also underwent right-heart catheterization, intra-aortic balloon pumping and bypass surgery significantly more often. Although patients with rupture had less severe coronary disease, their in-hospital mortality was higher (87% vs. 61%, p < 0.001). Surgical repair was performed in 31 patients with rupture (21 had concomitant bypass surgery); 6 (19%) survived. Of the 24 patients managed medically, only 1 survived.CONCLUSIONS There is a high in-hospital mortality rate when CS develops as a result of VSR. Ventricular septal rupture may occur early after infarction, and women and the elderly may be more susceptible. Although the prognosis is poor, surgery remains the best therapeutic option in this setting, (J Am Coll Cardiol 2000;36:1110-6) (C) 2000 by the American College of Cardiology.