Predictive factors of cardiac rupture in patients with ST-elevation myocardial infarction
Geng Qian1, Chen Wu, Yun-dai Chen
1Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China; Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; Department of Cardiology, Lujiang People's Hospital, Anhui 231500, China.
Insights
Cardiac rupture (CR) is a rare but deadly complication of ST-elevation myocardial infarction (STEMI). This study identified key risk factors including age, gender, and anemia, highlighting hemoglobin and white blood cell levels as crucial indicators.
Area of Science:
- Cardiology
- Internal Medicine
- Critical Care Medicine
Background:
- Cardiac rupture (CR) is a severe mechanical complication following ST-elevation myocardial infarction (STEMI).
- Understanding the incidence and risk factors for CR is crucial for improving patient outcomes.
- Previous studies have not fully elucidated the independent predictors of CR in diverse populations.
Purpose of the Study:
- To determine the incidence and identify independent risk factors for cardiac rupture (CR) in a large cohort of Chinese patients with ST-elevation myocardial infarction (STEMI).
- To investigate the specific roles of hemoglobin and white blood cell (WBC) counts in the occurrence of CR.
- To provide evidence for early risk stratification and targeted interventions in STEMI patients.
Main Methods:
- Retrospective analysis of 9798 consecutive STEMI patients from four Chinese centers.
- Comparison of clinical characteristics between patients with CR (n=178) and a control group without CR.
- Multivariable logistic regression analysis to identify independent risk factors for CR, adjusting for potential confounders.
Main Results:
- The incidence of CR in STEMI patients was 1.82%, with a high 30-day mortality of 61.2%.
- Independent risk factors for CR included advanced age, female gender, anemia, higher heart rate, anterior myocardial infarction, elevated WBC count, delayed hospital admission, and renal dysfunction.
- Lower hemoglobin levels (OR: 0.82) and higher WBC counts (OR: 1.08) were independently associated with CR occurrence.
Conclusions:
- Hemoglobin and WBC levels are independently correlated with the occurrence of cardiac rupture in STEMI patients.
- Early identification of risk factors such as anemia, elevated WBC, and delayed admission can aid in managing STEMI patients at high risk for CR.
- This study underscores the importance of monitoring hematological parameters in STEMI management to predict and potentially prevent cardiac rupture.
Abstract:
Cardiac rupture (CR) is a potentially fatal mechanical complication of ST-elevation myocardial infarction (STEMI). We aimed to determine the incidence and risk factors of CR in Chinese STEMI patients. A total of 9798 consecutive STEMI patients from four centers in China were retrospectively analyzed, among which 178 patients had CR. STEMI patients without CR were chosen as a control group. Clinical characteristics were compared between STEMI patients with CR and those without CR. The incidence of CR in STEMI patients was 1.82%, and the 30-d mortality was up to 61.2%. CR patients were significantly older, more female, and associated with a longer time from onset of pain to hospital admission than their non-CR counterparts (P<0.001). More patients with anterior myocardial infarction (82.1%) were found in the CR group, and CR patients had significantly higher heart rates than the control group ((91±19) bpm vs. (71±16) bpm; P<0.001). In multiple-adjusted models, the independent risk factors of CR were advanced age, female gender, anaemia, increased heart rate, anterior myocardial infarction, increased white blood cell (WBC) count, delayed admission, and renal dysfunction. The level of hemoglobin remained a significant determinant factor of CR (OR (95% CI): 0.82 (0.75-0.89); P<0.001) after adjusting for various potential confounding factors. Counts of WBC also remained a significant determinant of the CR (OR (95% CI): 1.08 (1.04-1.12); P<0.001). A number of variables were independently related to CR. This study indicated, for the first time, that both hemoglobin and WBC levels were independently correlated with occurrence of CR.
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