老年患者经皮冠状动脉介入治疗围手术期出血与术后1年预后的关系

Association between perioperative bleeding post percutaneous coronary intervention and 1 year clinical outcomes in elderly patients

目的 探讨老年冠心病患者经皮冠状动脉介入治疗（PCI）围手术期出血与术后1年主要不良心血管事件的关系.方法 2006年6月至2011年8月,前瞻性纳入在阜外心血管病医院行PCI的老年（≥75岁）冠心病患者1 105例.将患者分为出血组（围手术期发生出血,共153例）和无出血组（围手术期无出血,共952例）.利用Cox比例风险回归模型分析出血与术后1年死亡和心肌梗死复合终点的关系.结果 出血学术研究联合会（BARC）2级出血比例为9.5％（105/1 105）,≥2级出血比例为11.8％ （130/1 105）;穿刺点相关出血占所有出血的62.7％（96/153）.出血组术后1年死亡和心肌梗死复合终点事件率高于无出血组[9.2％（14/153）比4.2％（40/952）,P=0.008],心原性死亡比例也高于无出血组[3.9％ （6/153）比0.8％（8/952）,P=0.007],而非心原性死亡比例两组间差异无统计学意义（P=0.360）.Cox比例风险模型分析显示,以无出血为对照,BARC≥2级出血术后1年死亡和心肌梗死复合终点的HR值为2.368（95％ CI：1.201-4.669,P=0.013）.结论 PCI围手术期出血是≥75岁冠心病患者术后1年死亡和心肌梗死复合事件的独立危险因素.

Objective To evaluate the association between perioperative bleeding post percutaneous coronary intervention（PCI） and 1 year adverse cardiovascular events in elderly patients.Methods From June 2006 to August 2011,1 105 elderly （≥ 75 years） patients undergoing PCI in Fuwai Hospital were prospectively included.Patients were divided into peri-procedure bleeding group （n =153） and no bleeding group （n =952）.Cox proportional hazards model was performed to evaluate the independent effect of bleeding on the composite endpoint of death and myocardial infarction.Results BARC 2 grade bleeding occurred in 9.5% （105/1 105）patients.The rate of BARC ≥2 grade bleeding was 11.8% （130/1 105）,and the access site-related bleeding accounted for 62.7% （96/153）of all bleeding.The composite endpoint of 1 year death and myocardial infarction was higher in bleeding group （9.2% （14/153） vs.4.2% （40/952）,P =0.008）.The 1 year cardiac death was higher in bleeding group （3.9% （6/153）vs.0.8% （8/952）,P =0.007）,but the rate of non-cardiac death was similar between bleeding group and no bleeding group（P =0.360）.Cox proportional hazards model analysis showed that HR of 1 year death and myocardial infarction in BARC ≥2 grade bleeding patients was 2.368 （95% CI：1.201-4.669,P =0.013） compared with no bleeding patients.Conclusion Perioperative bleeding post PCI is an independent predictor of 1 year adverse outcomes in elderly patients（≥75 years）.