Factors related to cardiac rupture after acute myocardial infarction
Xue Gao1, Ying Guo1, Xiaoting Zhu1
1Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China.
Insights
Identifying risk factors for cardiac rupture (CR) after acute myocardial infarction (AMI) is crucial. Factors like low albumin, high white blood cell count, and anterior MI predict CR, with gender-specific differences in risk factors and mortality predictors.
Area of Science:
- Cardiology
- Internal Medicine
- Medical Research
Background:
- Cardiac rupture (CR) is a fatal complication following acute myocardial infarction (AMI).
- Early identification of CR risk factors in high-risk patients can potentially reduce mortality.
- Understanding predictors of in-hospital mortality from CR is essential for clinical management.
Purpose of the Study:
- To identify risk factors associated with CR after AMI.
- To determine predictors of in-hospital mortality among patients who develop CR.
- To explore potential gender-specific differences in CR risk and outcomes.
Main Methods:
- Retrospective analysis of 1,699 AMI cases (October 2013 - May 2020).
- Inclusion of 51 CR cases, matched 1:4 with non-CR AMI patients.
- Application of univariate/multivariate logistic and Cox regression analyses, including stratifying analysis by gender.
Main Results:
- CR incidence was 3.0% with a 57% in-hospital mortality rate.
- Independent predictors for CR included low albumin, high white blood cell count, elevated neutrophil percentage, anterior MI, and Killip class >II.
- Gender-specific risk factors were identified (e.g., triglycerides, troponin I in males; age, SBP, bicarbonate in females), while anterior MI, Killip class >II, and neutrophil percentage were common.
- Time to CR, CR site, and platelet count predicted in-hospital mortality, with platelet count being significant in both genders.
Conclusions:
- Low albumin, high WBC, elevated neutrophils, anterior MI, and Killip class >II are significant predictors of CR post-AMI.
- Distinct risk factors exist for male and female CR patients.
- Time from symptom onset to CR, CR location, and platelet count are key predictors of mortality, highlighting the importance of considering gender in CR management.
Background:
Cardiac rupture (CR) after acute myocardial infarction (AMI) is a fatal mechanical complication. The early identification of factors related to CR in high-risk cases may reduce mortality. The purpose of our study was to discover relevant risk factors for CR after AMI and in-hospital mortality from CR.
Methods:
In this study, we enrolled 1,699 AMI cases from October 2013 to May 2020. A total of 51 cases were diagnosed with CR. Clinical diagnostic information was recorded and analyzed retrospectively. We randomly matched these cases with AMI patients without CR in a 1:4 ratio. Univariate and multivariate logistic regression and stratifying analysis were used to identify risk factors for CR. Univariate and multivariate Cox regression hazard analysis and stratifying analysis were used to assess predictors of in-hospital mortality from CR.
Results:
The incidence of CR after AMI was 3.0% and in-hospital mortality was approximately 57%. Multivariate logistic regression analysis identified that white blood cell count, neutrophil percentage, anterior myocardial infarction, a Killip class of >II, and albumin level were independently associated with CR (p < 0.05). Stratifying analysis showed that age, systolic blood pressure, and bicarbonate were independent risk factors for female CR (p < 0.05) but not male CR. Triglyceride and cardiac troponin I were independent risk factors for male CR (p < 0.05) but not female CR. Anterior myocardial infarction, a Killip class of >II, and neutrophil percentage were independent risk factors for male and female CR (p < 0.05). Multivariate Cox regression analysis showed that the time from symptom to CR and the site of CR were independent predictors for in-hospital mortality from CR (p < 0.05). Stratification analysis indicated that risk factors did not differ based on gender, but platelet counts were predictors for in-hospital mortality in female and male CR.
Conclusion:
Low albumin, a high white blood cell count, neutrophil percentage, anterior myocardial infarction, and a Killip class of >II were independent and significant predictors for CR. However, risk factors are different in male and female CR. The time from symptom to CR, the site of CR, and platelet counts were independent predictors for in-hospital mortality from CR. These may be helpful in the early and accurate identification of high-risk patients with CR and the assessment of prognosis. In addition, gender differences should be considered.
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