Key result
Acute myocardial infarction in the high lateral wall was a significant risk factor for cardiac rupture in STEMI patients (OR 5.527; 95% CI 2.798-10.918; P<0.001).
Why the study?
In the PCI era, more clinically valuable risk factors are needed to determine the occurrence of cardiac rupture in patients with STEMI.
Case-Control (n=585)
Yes
Odds Ratio: 5.527 (95% CI 2.798–10.918)
p-value: p=<0.001
Acute myocardial infarction in the high lateral wall, along with non-single lesions and TIMI grades in PCI patients, are significant risk factors for cardiac rupture in STEMI.
High lateral STEMI may flag higher rupture risk; leaves open whether targeted monitoring improves outcomes.
Background: In percutaneous coronary intervention (PCI) era, more clinically valuable risk factors are still needed to determine the occurrence of cardiac rupture (CR). Therefore, we aimed to provide evidence for the early identification of CR in ST-segment elevation myocardial infarction (STEMI). Methods: A total of 22,016 consecutive patients with STEMI admitted to Cangzhou Central Hospital and Tianjin Chest Hospital from January 2013 to July 2021 were retrospectively included, among which 195 patients with CR were included as CR group. From the rest 21,820 STEMI patients without CR, 390 patients at a ratio of 1:2 were included as the control group. A total of 66 patients accepted PCI in the CR group, and 132 patients who accepted PCI in the control group at a ratio of 1:2 were included. The status of first medical contact, laboratory examinations, and PCI characteristics were recorded. Multivariate logistic regression analysis was used to investigate the risk factors related to CR. Results: 45.5%, P=0.004). Female (OR =2.318, 95% CI: 1.431-3.754, P=0.001), age (OR =1.066, 95% CI: 1.041-1.093, P<0.001), smoking (OR =1.750, 95% CI: 1.086-2.820, P=0.022), total chest pain time (OR =1.017, 95% CI: 1.000-1.035, P=0.049), recurrent acute chest pain (OR =2.750, 95% CI: 1.535-4.927, P=0.001), acute myocardial infarction (AMI) in the high lateral wall indicated by ECG (OR =5.527, 95% CI: 2.798-10.918, P<0.001), acute heart failure (OR =3.585, 95% CI: 2.074-6.195, P<0.001), and NT-proBNP level (OR =1.000, 95% CI: 1.000-1.000, P=0.023) were risk factors for CR in all patients. In patients who accepted PCI, single lesion (OR =0.421, 95% CI: 0.204-0.867, P=0.019), preoperative thrombolysis in myocardial infarction (TIMI) grade (OR =0.358, 95% CI: 0.169-0.760, P=0.007), and postoperative TIMI grade (OR =0.222, 95% CI: 0.090-0.546, P=0.001) were risk factors for CR. Conclusions: Non-single lesions and preoperative and postoperative TIMI grades were risk factors for CR in patients who accepted PCI. In addition to previously reported indicators, we found that AMI in the high lateral wall maybe helpful in early and accurate identification and prevention of possible CR.
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Xu et al. (2022) conducted a case-control in ST-segment elevation myocardial infarction (STEMI) (n=585). Clinical and procedural risk factors (e.g., AMI in high lateral wall, TIMI grade) vs. Absence of risk factors was evaluated on Cardiac rupture (OR 5.527, 95% CI 2.798-10.918, p=<0.001). Acute myocardial infarction in the high lateral wall was a significant risk factor for cardiac rupture in STEMI patients (OR 5.527; 95% CI 2.798-10.918; P<0.001).
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