背景:心肌梗死(MI)的一种众所周知的致命并发症是梗死后室间隔破裂(VSR)。这些患者与冠状动脉造影和随后的冠状动脉旁路移植术相关的益处和风险引发了争议。这项研究的目的是确定MI后血运重建的结果。
方法:从2011年至2017年,考虑55至78岁的患者发生梗死后室间隔破裂。年龄等因素,性别,人体测量,收缩压和舒张压(SBP和DBP),和生化参数如CPK-MB,胆固醇,低密度脂蛋白,高密度脂蛋白,和甘油三酯使用标准方法测量。估计的肾小球滤过率(eGFR),衡量肾功能,也决心。此外,冠状动脉造影因素,包括心电图改变,左心室(LV)收缩功能,右心室(RV)功能,肺动脉压(PAP),VSR的近端冠状动脉病变,收缩期PAP,右心房压力(RAP),并确定死亡率。
结果:本研究共纳入了81例因梗死后VSR接受手术治疗的患者。这些患者分为两组:幸存者(n=35)和非幸存者(N=41)。幸存者组的平均收缩压和舒张压较高(115.3±18.7vs.96.3±25.3和74.6±12.2vs.61.2±19.0,P=0.001)。2.9%的幸存者和9.8%的非幸存者进行了PCI。血管造影数据显示,17例(33%)和33例(63%)患者有单发和多发冠状动脉疾病,分别。非存活组CPK-MB水平显著高于非存活组(P<0.05)。超声心动图检查结果,包括左心室射血分数,RV射血分数,收缩期PAP,和VSR的解剖位置,幸存者和非幸存者之间没有显着差异。
结论:基于这些发现,建议在梗死后室间隔破裂的手术修复期间避免完全血运重建,因为它不会改善结果。
BACKGROUND: A well-known and fatal complication of myocardial infarction (
MI) is post-infarction ventricular septal rupture (VSR). The benefits and risks associated with coronary angiography and subsequent coronary artery bypass grafting in these patients have sparked controversy. The aim of this study was to determine the outcome of revascularization following
MI.
METHODS: Patients aged between 55 and 78 years were considered for the post-infarction ventricular septal rupture from 2011 to 2017. Factors such as age, sex, anthropometric measurements, systolic and diastolic blood pressure (SBP and DBP), and biochemical parameters like CPK-MB, cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides were measured using standard methods.The estimated Glomerular Filtration Rate (eGFR), a measure of kidney function, was also determined. Additionally, coronary angiographic factors including ECG changes, left ventricular (LV) systolic function, right ventricular (RV) function, Pulmonary Artery Pressure (PAP), proximal coronary lesions in VSR, systolic PAP, Right Atrial Pressure (RAP), and mortality rate were determined.
RESULTS: The study enrolled a total of 81 patients who had been surgically treated for post-infarction VSR. These patients were divided into two groups: survivors (n=35) and non-survivors (N=41). The mean systolic and diastolic blood pressure was higher in the survivor group (115.3 ± 18.7 vs. 96.3 ± 25.3 and 74.6 ± 12.2 vs. 61.2 ± 19.0, P=0.001). PCI was performed in 2.9% of survivors and 9.8% of non-survivors. Angiographic data revealed that 17 (33%) and 33 (63%) patients had single and multiple coronary artery diseases, respectively. CPK-MB levels were significantly higher in the non-survivors group (P<0.05). Echocardiographic findings, including LV ejection fraction, RV ejection fraction, systolic PAP, and the anatomic location of VSR, did not significantly differ between survivors and non-survivors.
CONCLUSIONS: Based on these findings, it is recommended to avoid complete revascularization during surgical repair of post-infarction ventricular septal rupture, as it would not improve the outcome.