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Abstract: 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.

急性ST段抬高型心肌梗死继发心脏破裂的预测因素分析

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。
ST段抬高型心肌梗死；危险因素；贫血；心脏破裂

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