Trends in the clinical and pathological characteristics of cardiac rupture in patients with acute myocardial infarction over 35 years.
Trends in the clinical and pathological characteristics of cardiac rupture in patients with acute myocardial infarction over 35 years.
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DOI：
10.1161/jaha.114.000984
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发表时间：
2014-10-20
影响因子：
5.4
通讯作者：
Yasuda S
中科院分区：
文献类型：
--
作者：
Honda S;Asaumi Y;Yamane T;Nagai T;Miyagi T;Noguchi T;Anzai T;Goto Y;Ishihara M;Nishimura K;Ogawa H;Ishibashi-Ueda H;Yasuda S
近年来，急性心肌梗死（AMI）患者心脏破裂（CR）的临床、病理特征和发生率是否发生了变化，目前尚不清楚。在AMI患者中研究了CR的发生率和临床特征，这些患者分为3个队列：1977-1989年、1990-2000年和2001-2011年。在总共5699例患者中，144例被诊断为CR，45例存活。多年来，CR的发生率下降（1977-1989年，3.3%; 1990-2000年，2.8%; 2001-2011年，1.7%; P=0.002），这与广泛采用再灌注治疗有关。CR死亡率下降（1977-1989，90%; 1990-2000，56%; 2001-2011，50%; P=0.002），与急诊手术率增加相关。在多变量分析中，首次心肌梗死、前壁梗死、女性、高血压和年龄>70岁是CR的重要危险因素，而2001 - 2011年高血压对CR的影响较弱。直接经皮冠状动脉介入治疗（PPCI）是预防CR的重要保护因素。在64例CR的尸检病例中，接受PPCI或纤溶治疗者心肌出血发生率高于未接受再灌注治疗者（未接受再灌注治疗，18.0%;纤溶治疗，71.4%; PPCI，83.3%; P=0.001）。随着医疗水平的提高，CR的发病率和死亡率均有所下降。然而，首次心肌梗死、前壁梗死、女性和高龄仍然是CR的重要危险因素。针对再灌注诱导的心肌出血的辅助心脏保护在当前PPCI时代正在出现。
There is little known about whether the clinical and pathological characteristics and incidence of cardiac rupture (CR) in patients with acute myocardial infarction (AMI) have changed over the years. The incidence and clinical characteristics of CR were investigated in patients with AMI, who were divided into 3 cohorts: 1977–1989, 1990–2000, and 2001–2011. Of a total of 5699 patients, 144 were diagnosed with CR and 45 survived. Over the years, the incidence of CR decreased (1977–1989, 3.3%; 1990–2000, 2.8%; 2001–2011, 1.7%; P=0.002) in association with the widespread adoption of reperfusion therapy. The mortality rate of CR decreased (1977–1989, 90%; 1990–2000, 56%; 2001–2011, 50%; P=0.002) in association with an increase in the rate of emergent surgery. In multivariable analysis, first myocardial infarction, anterior infarct, female sex, hypertension, and age >70 years were significant risk factors for CR, whereas impact of hypertension on CR was weaker from 2001 to 2011. Primary percutaneous coronary intervention (PPCI) was a significant protective factor against CR. In 64 autopsy cases with CR, myocardial hemorrhage occurred more frequently in those who underwent PPCI or fibrinolysis than those who did not receive reperfusion therapy (no reperfusion therapy, 18.0%; fibrinolysis, 71.4%; PPCI, 83.3%; P=0.001). With the development of medical treatment, the incidence and mortality rate of CR have decreased. However, first myocardial infarction, anterior infarct, female sex, and old age remain important risk factors for CR. Adjunctive cardioprotection against reperfusion‐induced myocardial hemorrhage is emerging in the current PPCI era.