Long-term outcome and risk prediction in patients suffering acute myocardial infarction complicated by post-infarction cardiac rupture

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• 作者：Patrick Sulzgruber^a ; Feras El-Hamid^a ; Lorenz Koller^a ; Stefan Forster^a ; Georg Goliasch^a ; Johann Wojta^a ; ^b ; ^c ; Alexander Niessner^a ; ^{alexander.niessner@meduniwien.ac.at}
• 关键词：Acute myocardial infarction ; Cardiac rupture ; Mortality ; Prognostication
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：15 January 2017
• 年：2017
• 卷：227
• 期：Complete
• 页码：399-403
• 全文大小：214 K
• 卷排序：227

文摘

Post-infarction cardiac rupture (CR) such as ventricular septal rupture (VSR), free wall rupture (FWR), atrial septal rupture (ASR) or papillary muscle rupture (PMR) is a rare but dreaded complication in patients with acute myocardial infarction (AMI) associated with a very poor prognosis with reported mortality rates between 60 and 100%. Therefore suitable risk stratification for secondary prevention seems crucial, but data on long-term survival und risk prediction in this especially vulnerable patient collective remains scarce.MethodsOut of 11,641 patients presenting with AMI a total of 28 individuals suffering post-infarction CR were identified and stratified in “acute survivors of CR” (n = 10) and “non-survivors of CR” (n = 18). Cox regression hazard analysis was used to assess prognosticators on long-term survival.ResultsTen patients (35.7%) survived the initial event. After a median follow-up time of 9 years 2 (20%) of the survivors died, both due to cardiovascular causes. Younger age (p = 0.023) and higher systolic blood pressure at admission (p = 0.018) turned out to be significant predictors of long-term survival. Systolic blood pressure 48 h after CR proved to be a strong and independent predictor for survival with an adjusted hazard ratio per one standard deviation of 0.89 (95% CI: 0.72–0.99; 0.048).ConclusionHemodynamic stabilization and severity of cardiogenic shock were detected as clinically most common among patients suffering post-infarction CR and proved to be of major importance for survival. If survival of the initial event was achieved, satisfying long-term mortality could be reached.