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研究目的: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。创新要点: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。研究方法: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。重要结论: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。
Research purposes: Cardiac rupture is one of the most serious complication of acute ST-segment elevation myocardial infarction, with dangerous condition and high mortality rate. By identifying the risk factors for cardiac rupture complications after myocardial infarction, early identification of high risk of heart failure crowd is conducive to early intervention in the treatment of acute myocardial infarction to reduce the incidence of heart rupture. Innovative points: The lack of a systematic risk assessment of secondary heart failure secondary to ST-elevation MI in China. In this study, a retrospective cohort study was conducted to improve and perfect the Chinese multicentre AMI database. The total sample size was 9,798 For example, for the domestic sample of the same type of research most. Previous foreign literature reports: women, elderly, delayed treatment after myocardial infarction, anterior myocardial infarction, thrombolytic therapy is an independent risk factor for heart failure after myocardial infarction. This study is based on the Chinese population to verify the above risk factors based on the first proposed at the time of treatment, hemoglobin and leukocyte count rise is closely related to subsequent heart failure. The discovery of new predictors of cardiac rupture favors stratification of the more delicate heart rupture and early identification of at-risk heart ruptures. Methods: To establish a database of multicentre myocardial infarction in China and compare the clinical features of patients with and without heart rupture to screen independent predictors of heart-specific and sensitive heart rupture. Important conclusions: The incidence of heart rupture after acute STEMI in Chinese population was 1.82%. The independent predictors mainly included elderly and females. The resting heart rate, anterior myocardial infarction, cardiac dysfunction, Delay in treatment time, renal insufficiency, anemia and elevated white blood cell count. This is the first time that the proposed treatment of anemia and elevated white blood cell count is directly related to the occurrence of heart rupture.