Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction
Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction
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DOI：
10.1161/01.cir.101.1.27
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发表时间：
2000-01-04
期刊：
影响因子：
37.8
通讯作者：
Topol, EJ
中科院分区：
文献类型：
--
作者：
Crenshaw, BS;Granger, CB;Topol, EJ
室间隔缺损（VSD）并发急性心肌梗死的研究主要在溶栓前的小型试验中进行。我们的目标是确定临床预测因素和血管造影和临床结果，这种并发症在溶栓时代，方法和结果，我们比较了登记的特点，血管造影模式，和结果（30天和1年死亡率）的全球利用链激酶和TPA闭塞的冠状动脉（GUSTO-I）试验，并没有确诊为VSD的患者。单变量和多变量分析用于评估入组因素与VSD发展之间的关系。总的来说，41021例患者中有84例（0.2%）发生了VSD，这一比例低于溶栓前报告的比例。从症状发作到VSD诊断的中位时间为1天。与该并发症最相关的入组因素是高龄、前壁梗死、女性和既往无吸烟史。室间隔缺损患者的梗死动脉多位于左前降支，且更易完全闭塞。VSD患者的30天死亡率高于无此并发症的患者（73.8%对6.8%，P
Background-Ventricular septal defect (VSD) complicating acute myocardial infarction has been studied primarily in small, prethrombolytic-era trials. Our goal was to determine clinical predictors and angiographic and clinical outcomes of this complication in the thrombolytic era.Methods and Results-We compared enrollment characteristics, angiographic patterns, and outcomes (30-day and 1-year mortality) of patients enrolled in the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries (GUSTO-I) trial with and without a confirmed diagnosis of VSD. Univariable and multivariable analyses were used to assess relations between enrollment factors and the development of VSD. In all, 84 of the 41 021 patients (0.2%) developed VSD, a smaller percentage than reported in the prethrombolytic era. The median time from symptom onset to VSD diagnosis was 1 day. Enrollment factors most associated with this complication were advanced age, anterior infarction, female sex, and no previous smoking. The infarct artery was more often the left anterior descending and more likely to be totally occluded in patients who developed VSD. Mortality at 30 days was higher in patients with VSDs than in those without this complication (73.8% versus 6.8%, P