摘要
目的:评估院内发生急性上消化道出血(UGIB)的老年急性冠状动脉综合征(ACS)患者的临床特征,随访再发出血和出现不良心血管事件(MACE)情况,并分析随访再发有临床意义出血的危险因素。方法:回顾性病例对照研究。连续纳入北京安贞医院2016年12月到2018年12月,收治的PCI治疗的、临床资料和随访资料完整的老年ACS患者1780例,根据PCI术后院内是否发生UGIB,将患者分为出血组(43例)和对照组(1737例),分析并比较两组间的基线资料情况。随访截止时间为2019年6月30日,主要终点是评估再发有临床意义出血的情况,出血事件参照出血学术研究会(BARC)出血定义。结果:ACS行PCI治疗的患者1780例中,年龄为60-80岁,中位年龄为68.7岁,43例(2.4%)院内发生UGIB,中位出血时间为PCI术后2.9 d,出血主要原因为胃溃疡(24例,55.8%)和十二指肠溃疡(11例,25.6%)。与对照组相比,出血组患者年龄更大(69.5©s.67.2)岁,合并慢性肾脏病(11.6%©s.3.0%)和消化性溃疡(9.3%©s.3.0%)病史比例更高,入院前阿司匹林(65.1%©s.40.2%)、替格瑞洛(20.9%©s.12.0%)和口服抗凝剂(14.0%©s.5.8%)使用率更高(均P<0.05)。住院期间,冠状动脉造影结果显示:两组的罪犯血管分布差异有统计学意义(P<0.05)。平均随访(15.4±4.3)个月,发现出血组的BARC 5型(4.7%©s.1.1%)、严重出血(9.3%©s.2.9%)、有临床意义的出血(20.9%©s.9.4%,X2=6.408,P=0.011)和MACE事件(34.8%©s.21.5%,X2=5.364,P=0.021)等发生率均显著高于对照组(P<0.05)。Cox多因素回归分析显示:年龄M70岁(HR=1.837,95%CI:1.076-3.251,P=0.039)、消化性溃疡病史(HR=2.186,95%CI:1.173-4.136,P=0.017)、慢性肾脏病(HR=2.672,95%CI:1.3583.907,P=0.003)、口服抗凝剂(HR=2.458,95%CI:1.156-3.710,P=0.021)均为再发有临床意义出血的独立危险因素,PPI的使用可降低再发出血风险(HR=0.589,95%CI:0.405-0.974,P=0.042)。结论:ACS患者行PCI术后院内发生UGIB的风险较高,UGIB可增加随访再发有临床意义出血和MACE事件的风险,而高龄、消化性溃疡病史、肾脏病史及口服抗凝剂是危险因素,而PPI的使用可能是其保护因素。
Objective:To assess the clinical characteristics of elderly patients with acute coronary syndrome(ACS)who have acute upper gastrointestinal bleeding(UGIB)in the hospital,follow-up recurrence of blood and adverse cardiovascular events(MACE),and analyze follow-up recurrence of clinically significant bleeding Risk factors.Methods:Retrospective case-control study.The 1780 elderly ACS patients with complete clinical data and follow-up data who were admitted to the Beijing Anzhen Hospital from December 2016 to December 2018 were continuously included in the PCI treatment.According to whether UGIB occurred in the hospital after PCI,the patients were divided into bleeding groups(43 cases)and the control group(1737 cases),analyze and compare the baseline data between the two groups.The deadline for follow-up is June 30,2019.The primary endpoint is to evaluate the recurrence of clinically significant bleeding.For bleeding events,refer to the definition of bleeding from the Bleeding Academic Research Council(BARC).Results:Among the 1780 ACS patients who underwent PCI treatment,the age was 60-80 years,the median age was 68.7 years,43 cases(2.4%)had UGIB in the hospital,and the median bleeding time was 2.9 days after PCI.The main causes were gastric ulcer(24 cases,55.8%)and duodenal ulcer(11 cases,25.6%).Compared with the control group,patients in the bleeding group were older(69.5 vs.67.2 years old),had a higher proportion of patients with chronic kidney disease(11.6%vs.3.0%)and peptic ulcer(9.3%vs.3.0%),and aspirin before admission(65.1%vs.40.2%),ticagrelor(20.9%vs.12.0%)and oral anticoagulants(14.0%vs.5.8%)had higher usage rates(all P<0.05).During hospitalization,the result of coronary angiography showed that there was a significant difference in the distribution of blood vessels of the criminals between the two groups(P<0.05).The average follow-up was(15.4±4.3)months.The incidences of BARC type 5(4.7%vs.1.1%),severe bleeding(9.3%vs.2.9%),clinically significant bleeding(20.9%vs.9.4%,X2=6.408,P=0.011)and MACE events(34.8%vs.21.5%,X2=5.364,P=0.021)in the bleeding group were significantly higher than Control group(P<0.05).Cox multivariate regression analysis showed:age M70 years old(HR=1.837,95%CI:1.076—3.251,P=0.039),history of peptic ulcer(HR=2.186,95%CI:1.173—4.136,P=0.017),Chronic kidney disease(HR=2.672,95%CI:1.358-3.907,P=0.003),oral anticoagulants(HR=2.458,95%CI:1.156-3.710,P=0.021)are all follow-up after PCI As an independent risk factor for clinically significant bleeding,the use of PPI can reduce the risk of recurrence(HR=0.589,95%CI:0.405-0.974,P=0.042).Conclusions:ACS patients have a higher risk of developing UGIB in the hospital after PCI.UGIB can increase the risk of recurring clinically significant bleeding and MACE events during follow-up.Old age,history of peptic ulcer,history of kidney disease,and oral anticoagulants are risk factors,and the use of PPI may be its protective factor.
作者
齐疏影
李响
屈超
刘潇潇
QI Shuying;Ll Xiang;QU Chao;LlU Xiaoxi-ao(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)
出处
《心肺血管病杂志》
CAS
2021年第4期324-329,共6页
Journal of Cardiovascular and Pulmonary Diseases
基金
北京市科技新星计划(Z151100000315067)。
