Risk of cardiac rupture among elderly patients with diabetes presenting with first acute myocardial infarction
ObjectiveWe aimed to analyze the risk of cardiac rupture (CR) in aged diabetic patients with acute ST-segment elevated myocardial infarction (STEMI) who were followed up for one month, and analyze its independent risk factors.MethodsA total of 3063 aged patients with first onset STEMI admitted to Be...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-09-01
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| Series: | Frontiers in Endocrinology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2023.1239644/full |
| _version_ | 1797680748304531456 |
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| author | Xiaolin Zu Yanyan Jin Yaping Zeng Peng Li Hai Gao |
| author_facet | Xiaolin Zu Yanyan Jin Yaping Zeng Peng Li Hai Gao |
| author_sort | Xiaolin Zu |
| collection | DOAJ |
| description | ObjectiveWe aimed to analyze the risk of cardiac rupture (CR) in aged diabetic patients with acute ST-segment elevated myocardial infarction (STEMI) who were followed up for one month, and analyze its independent risk factors.MethodsA total of 3063 aged patients with first onset STEMI admitted to Beijing Anzhen Hospital from January 2001 to December 2020 were retrospectively included. There were 2020 patients without diabetes mellitus (DM) and 1043 patients with DM. We used propensity scores matching (PSM) method to balance baseline exposure factors between patients with or without DM, and all were divided the DM group (1043 cases) and the non-DM group (1043 cases) after the PSM. The primary outcome was CR (the composite rate of papillary muscle rupture, ventricular septum perforation, free wall rupture), which was diagnosed based on clinical manifestations and/or echocardiographic findings. Kaplan-meier survival analyses and log-rank test was used to evaluate the risk of CR between the two groups, and Cox regression analysis was used to evaluate the independent risk factors for CR.ResultsAfter PSM, the baseline clinical data were similar between the DM and non-DM group (all P>0.05). However, level of glycated hemoglobin was significantly higher in the DM group (P<0.05). During 1 month of follow-up, there were 55 (2.64%) cases of CR, most occurred within 48h after admission (40 cases). Among the 55 cases, 11(0.53%) had papillary muscle rupture, 18(0.86%) had ventricular septum perforation, and 26(1.25%) had free wall rupture. Kaplan-meier survival analyses detected that the DM group was associated with significantly increased risk of CR (3.36% vs. 1.92%, HR=1.532, 95% CI: 1.054-2.346, P=0.030), ventricular septum perforation (1.05% vs. 0.67%, HR=1.464, 95% CI: 1.021-2.099, P=0.038) and free wall rupture (1.63% vs. 0.86%, HR=1.861, 95% CI: 1.074-3.225, P=0.027) than those in the non-DM group. Among the 2031 aged STEMI patients without CR, 144 cases (6.90%, 144/2086) died; and among the 55 patients with CR, 37 cases (1.77%, 37/2086) died due to CR. Therefore, twenty percent (20.44%, 37/181) of death was due to CR. Multivariate Cox regression analysis indicated that DM (HR=1.532, 95%CI: 1.054-2.346), age (HR=1.390, 95%CI: 1.079-1.791), female (HR=1.183, 95%CI: 1.049-1.334), troponin I (HR=1.364, 95%CI: 1.108-1.679), brain natriuretic peptide (HR=1.512, 95%CI: 1.069-2.139), revascularization (HR=0.827, 95%CI: 0.731-0.936) and β-receptor blocker (HR=0.849, 95%CI: 0.760-0.948) were independent risk factors of CR (all P<0.05).ConclusionDM as well as a few other factors, are independent determinants of CR. CR is not a rare event among the aged STEMI patients and twenty percent of deaths are due to CR. However, large sample-sized studies are warranted to confirm these findings. |
| first_indexed | 2024-03-11T23:34:36Z |
| format | Article |
| id | doaj.art-36fb17d5b79b4f4b902ef295840201ca |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-03-11T23:34:36Z |
| publishDate | 2023-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-36fb17d5b79b4f4b902ef295840201ca2023-09-20T04:52:15ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922023-09-011410.3389/fendo.2023.12396441239644Risk of cardiac rupture among elderly patients with diabetes presenting with first acute myocardial infarctionXiaolin Zu0Yanyan Jin1Yaping Zeng2Peng Li3Hai Gao4Department of Cardiology, Emergency Coronary Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaDepartment of Cardiology, Emergency Coronary Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaDepartment of Cardiology, Emergency Coronary Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaThe Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, ChinaDepartment of Cardiology, Emergency Coronary Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaObjectiveWe aimed to analyze the risk of cardiac rupture (CR) in aged diabetic patients with acute ST-segment elevated myocardial infarction (STEMI) who were followed up for one month, and analyze its independent risk factors.MethodsA total of 3063 aged patients with first onset STEMI admitted to Beijing Anzhen Hospital from January 2001 to December 2020 were retrospectively included. There were 2020 patients without diabetes mellitus (DM) and 1043 patients with DM. We used propensity scores matching (PSM) method to balance baseline exposure factors between patients with or without DM, and all were divided the DM group (1043 cases) and the non-DM group (1043 cases) after the PSM. The primary outcome was CR (the composite rate of papillary muscle rupture, ventricular septum perforation, free wall rupture), which was diagnosed based on clinical manifestations and/or echocardiographic findings. Kaplan-meier survival analyses and log-rank test was used to evaluate the risk of CR between the two groups, and Cox regression analysis was used to evaluate the independent risk factors for CR.ResultsAfter PSM, the baseline clinical data were similar between the DM and non-DM group (all P>0.05). However, level of glycated hemoglobin was significantly higher in the DM group (P<0.05). During 1 month of follow-up, there were 55 (2.64%) cases of CR, most occurred within 48h after admission (40 cases). Among the 55 cases, 11(0.53%) had papillary muscle rupture, 18(0.86%) had ventricular septum perforation, and 26(1.25%) had free wall rupture. Kaplan-meier survival analyses detected that the DM group was associated with significantly increased risk of CR (3.36% vs. 1.92%, HR=1.532, 95% CI: 1.054-2.346, P=0.030), ventricular septum perforation (1.05% vs. 0.67%, HR=1.464, 95% CI: 1.021-2.099, P=0.038) and free wall rupture (1.63% vs. 0.86%, HR=1.861, 95% CI: 1.074-3.225, P=0.027) than those in the non-DM group. Among the 2031 aged STEMI patients without CR, 144 cases (6.90%, 144/2086) died; and among the 55 patients with CR, 37 cases (1.77%, 37/2086) died due to CR. Therefore, twenty percent (20.44%, 37/181) of death was due to CR. Multivariate Cox regression analysis indicated that DM (HR=1.532, 95%CI: 1.054-2.346), age (HR=1.390, 95%CI: 1.079-1.791), female (HR=1.183, 95%CI: 1.049-1.334), troponin I (HR=1.364, 95%CI: 1.108-1.679), brain natriuretic peptide (HR=1.512, 95%CI: 1.069-2.139), revascularization (HR=0.827, 95%CI: 0.731-0.936) and β-receptor blocker (HR=0.849, 95%CI: 0.760-0.948) were independent risk factors of CR (all P<0.05).ConclusionDM as well as a few other factors, are independent determinants of CR. CR is not a rare event among the aged STEMI patients and twenty percent of deaths are due to CR. However, large sample-sized studies are warranted to confirm these findings.https://www.frontiersin.org/articles/10.3389/fendo.2023.1239644/fullacute ST-segment elevated myocardial infarctioncardiac ruptureadvanced agediabetesrisk factor |
| spellingShingle | Xiaolin Zu Yanyan Jin Yaping Zeng Peng Li Hai Gao Risk of cardiac rupture among elderly patients with diabetes presenting with first acute myocardial infarction Frontiers in Endocrinology acute ST-segment elevated myocardial infarction cardiac rupture advanced age diabetes risk factor |
| title | Risk of cardiac rupture among elderly patients with diabetes presenting with first acute myocardial infarction |
| title_full | Risk of cardiac rupture among elderly patients with diabetes presenting with first acute myocardial infarction |
| title_fullStr | Risk of cardiac rupture among elderly patients with diabetes presenting with first acute myocardial infarction |
| title_full_unstemmed | Risk of cardiac rupture among elderly patients with diabetes presenting with first acute myocardial infarction |
| title_short | Risk of cardiac rupture among elderly patients with diabetes presenting with first acute myocardial infarction |
| title_sort | risk of cardiac rupture among elderly patients with diabetes presenting with first acute myocardial infarction |
| topic | acute ST-segment elevated myocardial infarction cardiac rupture advanced age diabetes risk factor |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2023.1239644/full |
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