Full Text:   <1283>

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CLC number: R541.4

On-line Access: 2014-12-03

Received: 2014-04-03

Revision Accepted: 2014-08-07

Crosschecked: 2014-11-14

Cited: 4

Clicked: 2258

Citations:  Bibtex RefMan EndNote GB/T7714




Yun-dai CHEN


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Journal of Zhejiang University SCIENCE B 2014 Vol.15 No.12 P.1048-1054


Predictive factors of cardiac rupture in patients with ST-elevation myocardial infarction*

Author(s):  Geng Qian1, Chen Wu1, Yun-dai Chen1, Chen-chen Tu2, Jin-wen Wang2, Yong-an Qian3

Affiliation(s):  1. Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China; more

Corresponding email(s):   qiangeng9396@263.net

Key Words:  ST-elevation myocardial infarction, Risk factor, Anaemia, Cardiac rupture

Geng Qian, Chen Wu, Yun-dai Chen, Chen-chen Tu, Jin-wen Wang, Yong-an Qian. Predictive factors of cardiac rupture in patients with ST-elevation myocardial infarction[J]. Journal of Zhejiang University Science B, 2014, 15(12): 1048-1054.

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author="Geng Qian, Chen Wu, Yun-dai Chen, Chen-chen Tu, Jin-wen Wang, Yong-an Qian",
journal="Journal of Zhejiang University Science B",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%T Predictive factors of cardiac rupture in patients with ST-elevation myocardial infarction
%A Geng Qian
%A Chen Wu
%A Yun-dai Chen
%A Chen-chen Tu
%A Jin-wen Wang
%A Yong-an Qian
%J Journal of Zhejiang University SCIENCE B
%V 15
%N 12
%P 1048-1054
%@ 1673-1581
%D 2014
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1400095

T1 - Predictive factors of cardiac rupture in patients with ST-elevation myocardial infarction
A1 - Geng Qian
A1 - Chen Wu
A1 - Yun-dai Chen
A1 - Chen-chen Tu
A1 - Jin-wen Wang
A1 - Yong-an Qian
J0 - Journal of Zhejiang University Science B
VL - 15
IS - 12
SP - 1048
EP - 1054
%@ 1673-1581
Y1 - 2014
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1400095

cardiac rupture (CR) is a potentially fatal mechanical complication of ST-elevation myocardial infarction (STEMI). We aimed to determine the incidence and risk factors of CR in Chinese STEMI patients. A total of 9798 consecutive STEMI patients from four centers in China were retrospectively analyzed, among which 178 patients had CR. STEMI patients without CR were chosen as a control group. Clinical characteristics were compared between STEMI patients with CR and those without CR. The incidence of CR in STEMI patients was 1.82%, and the 30-d mortality was up to 61.2%. CR patients were significantly older, more female, and associated with a longer time from onset of pain to hospital admission than their non-CR counterparts (P<0.001). More patients with anterior myocardial infarction (82.1%) were found in the CR group, and CR patients had significantly higher heart rates than the control group ((91±19) bpm vs. (71±16) bpm; P<0.001). In multiple-adjusted models, the independent risk factors of CR were advanced age, female gender, anaemia, increased heart rate, anterior myocardial infarction, increased white blood cell (WBC) count, delayed admission, and renal dysfunction. The level of hemoglobin remained a significant determinant factor of CR (OR (95% CI): 0.82 (0.75–0.89); P<0.001) after adjusting for various potential confounding factors. Counts of WBC also remained a significant determinant of the CR (OR (95% CI): 1.08 (1.04–1.12); P<0.001). A number of variables were independently related to CR. This study indicated, for the first time, that both hemoglobin and WBC levels were independently correlated with occurrence of CR.


心脏破裂是急性ST段抬高型心肌梗死最严重的并发症之一,病情凶险,死亡率高。通过明确心肌梗死后出现心脏破裂并发症的危险因素,早期识别心脏破裂高危人群,有利于在急性心肌梗死的早期采取干预措施以减少心脏破裂的发生。 既往缺乏对中国ST段抬高型心肌梗死继发心脏破裂的系统风险评估,本研究采用回顾性队列研究的方法,完善并健全中国多中心的急性心肌梗死数据库,样本总量达到9798例,为国内同类研究中样本量最多。既往的国外文献报道:女性、高龄、心梗后就诊时间延迟、前壁心肌梗死、溶栓治疗等是心肌梗死后心脏破裂的独立危险因素。本研究在中国人群验证以上危险因素的基础上首次提出就诊时血色素下降及白细胞计数的升高与随后发生的心脏破裂密切相关。新的心脏破裂预测因素的发现有利于对心脏破裂更精细化的危险分层,早期识别心脏破裂高危人群。 建立中国多中心心肌梗死数据库,比较发生心脏破裂与未发生心脏破裂患者临床特点的差异,筛选敏感特异的心脏破裂的独立预测因素。 中国人群急性ST段抬高型心肌梗死后心脏破裂的发生率是1.82%,独立预测因素主要包括:高龄、女性、就诊时静息心率增快、前壁心肌梗死、心功能不全、就诊时间延迟、肾功能不全、贫血与白细胞计数升高。本文第一次提出就诊时贫血状态及白细胞计数的升高时与心脏破裂的发生直接相关。

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article


[1] Fang, L., Gao, X.M., Moore, X.L., 2007. Differences in inflammation, MMP activation and collagen damage account for gender difference in murine cardiac rupture following myocardial infarction. J Mol Cell Cardiol, 43(5):535-544. 

[2] Figueras, J., Alcalde, O., Barrabes, J.A., 2008. Changes in hospital mortality rates in 425 patients with acute ST-elevation myocardial infarction and cardiac rupture over a 30-year period. Circulation, 118(25):2783-2789. 

[3] Figueras, J., Barrabes, J.A., Serra, V., 2010. Hospital outcome of moderate to severe pericardial effusion complicating ST-elevation acute myocardial infarction. Circulation, 122(19):1902-1909. 

[4] French, J.K., Hellkamp, A.S., Armstrong, P.W., 2010. Mechanical complications after percutaneous coronary intervention in ST-elevation myocardial infarction (from APEX-AMI). Am J Cardiol, 105(1):59-63. 

[5] Gao, X.M., Ming, Z., Su, Y., 2010. Infarct size and post-infarct inflammation determine the risk of cardiac rupture in mice. Int J Cardiol, 143(1):20-28. 

[6] Gao, X.M., White, D.A., Dart, A.M., 2012. Post-infarct cardiac rupture: recent insights on pathogenesis and therapeutic interventions. Pharmacol Ther, 134(2):156-179. 

[7] Hutchins, K.D., Skurnick, J., Lavenhar, M., 2002. Cardiac rupture in acute myocardial infarction: a reassessment. Am J Forensic Med Pathol, 23(1):78-82. 

[8] Kawano, H., Miyauchi, K., Okada, R., 1994. Histopathological study of cardiac rupture following myocardial infarction with and without thrombolytic therapy. J Cardiol, 24(4):249-255. 

[9] Kushner, F.G., Hand, M., Smith, S.C., 2009. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation, 120(22):2271-2306. 

[10] Lewis, A.J., Burchell, H.B., Titus, J.L., 1969. Clinical and pathologic features of postinfarction cardiac rupture. Am J Cardiol, 23(1):43-53. 

[11] Lopez-Sendon, J., Gurfinkel, E.P., Lopez de Sa, E., 2010. Factors related to heart rupture in acute coronary syndromes in the global registry of acute coronary events. Eur Heart J, 31(12):1449-1456. 

[12] Markowicz-Pawlus, E., Nozynski, J., Sedkowska, A., 2007. Cardiac rupture risk estimation in patients with acute myocardial infarction treated with percutaneous coronary intervention. Cardiol J, 14(6):538-543. 

[13] Okino, S., Nishiyama, K., Ando, K., 2005. Thrombolysis increases the risk of free wall rupture in patients with acute myocardial infarction undergoing percutaneous coronary intervention. J Interv Cardiol, 18(3):167-172. 

[14] Pedrazzini, G., Santoro, E., Latini, R., 2008. Causes of death in patients with acute myocardial infarction treated with angiotensin-converting enzyme inhibitors: findings from the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto (GISSI)-3 trial. Am Heart J, 155(2):388-394. 

[15] Pliam, M.B., Sternlieb, J.J., 1993. Intramyocardial dissecting hematoma: an unusual form of subacute cardiac rupture. J Card Surg, 8(6):628-637. 

[16] Pouleur, A.C., Barkoudah, E., Uno, H., 2010. Pathogenesis of sudden unexpected death in a clinical trial of patients with myocardial infarction and left ventricular dysfunction, heart failure, or both. Circulation, 122(6):597-602. 

[17] Qian, G., Wang, Z.F., Liu, H.B., 2011. Clinical manifestations of 43 patients with acute myocardial infarction complicated by free wall rupture. Chin J Cardiovasc Dis, (in Chinese),39(9):812-815. 

[18] Qian, G., Liu, H.B., Wang, J.W., 2013. Risk of cardiac rupture after acute myocardial infarction is related to a risk of hemorrhage. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 14(8):736-742. 

[19] Shamshad, F., Kenchaiah, S., Finn, P.V., 2010. Fatal myocardial rupture after acute myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: the valsartan in acute myocardial infarction trial (VALIANT). Am Heart J, 160(1):145-151. 

[20] van den Borne, S.W., Cleutjens, J.P., Hanemaaijer, R., 2009. Increased matrix metalloproteinase-8 and -9 activity in patients with infarct rupture after myocardial infarction. Cardiovasc Pathol, 18(1):37-43. 

[21] Vargas-Barrn, J., Roldn, F.J., Romero-Crdenas, A., 2013. Intramyocardial dissecting hematoma and postinfarction cardiac rupture. Echocardiography, 30(1):106-113. 

[22] Yip, H.K., Wu, C.J., Chang, H.W., 2003. Cardiac rupture complicating acute myocardial infarction in the direct percutaneous coronary intervention reperfusion era. Chest, 124(2):565-571. 

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