Risk factors for cardiac rupture after acute ST-segment elevation myocardial infarction during the percutaneous coronary intervention era: a retrospective case-control study

Abstract

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: There was a higher proportion of patients with myocardial infarction (MI) in the high lateral wall in the CR group (23.6% vs. 8.2%, P<0.001). The proportion of single lesions was lower in the CR group (24.2% vs. 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.

Keywords: Cardiac rupture (CR); ST-segment elevation myocardial infarction; acute myocardial infarction in high lateral wall; percutaneous coronary intervention; thrombolysis in myocardial infarction grades.

Figure 1

Flow diagram. PCI, percutaneous coronary intervention; CR, cardiac rupture.

Figure 2

Multivariate logistic regression analysis of risk factors for CR in all patients. CR, cardiac rupture.

Figure 3

Multivariate logistic regression analysis of risk factors for CR in patients who accepted PCI. CR, cardiac rupture; PCI, percutaneous coronary intervention.

Figure 4

Ultrasound images of patients with CR. Long axis view of the left ventricle next to the sternum. The blue arrow shows the hemopericardium. CR, cardiac rupture.

Figure 5

Cardiac magnetic resonance images. (A) Fat-suppressed T1-weighted black blood sequence. The high signal of pericardial effusion suggests bloody effusion (white arrows). (B) Short-axis film sequence (FIESTA Cine) showed a strip-like low signal in the subendocardium of the inferior wall and the inferior septal wall at the proximal apical region (white arrows), suggesting a local infarction with minimal intramuscular bleeding. (C) Short-axis delayed enhanced images (8 min) showed partially transmural delayed enhancement area of the subendocardium of the inferior wall and the inferior septal wall at the proximal apical region (white arrows), suggesting MI. MI, myocardial infarction.