非ST段抬高型急性冠状动脉综合征患者行经皮冠状动脉介入术后大出血事件的发生率及预测因素和预后

Incidence, predictors and prognosis of major bleeding events after percutaneous coronary intervention in treating non-ST-segment elevated acute coronary syndrome

目的 探讨非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者经皮冠状动脉介入（PCI）术后大出血发生率、预测因素和预后。方法 回顾性分析2015年1—6月首都医科大学附属北京安贞医院连续收治的3 817例NSTE-ACS行PCI并接受药物洗脱支架置入患者的临床资料。分析PCI术后1年内发生大出血事件的独立危险因素及PCI术后30 d内和1年内大出血事件与全因死亡和主要不良心血管事件（MACE）的关系。结果 随访1年内，大出血事件共发生50例（1.3%）。PCI术后1年内发生大出血事件的独立危险因素包括女性、入院收缩压≤120 mmHg（1 mmHg=0.133 kPa）、入院心率＞80次/min、既往冠状动脉血运重建、既往消化性溃疡、股动脉穿刺、住院期间联合应用双联抗血小板药物＋糖蛋白Ⅱb/Ⅲa受体拮抗剂＋低分子肝素/磺达肝癸钠抗栓治疗（均P＜0.05）。PCI术后大出血事件与30 d内和1年内的全因死亡密切相关（均P〈0.05）；同时，PCI术后大出血事件与30 d内MACE密切相关（P〈0.05），却与1年内MACE无关（P＞0.05）。结论 NSTE-ACS患者PCI术后1年内大出血事件发生率为1.3%，发生大出血的患者继发全因死亡和MACE的时间多在PCI术后30 d内。

Objective To investigate the incidence, predictors and prognosis of major bleeding events in patients with non-ST-elevation acute coronary syndrome（NSTE-ACS） after percutaneous coronary intervention（PCI）. Methods Totally 3 817 NSTE-ACS patients who had PCI with drug eluting stent implantation from January to June 2015 in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. Post PCI major bleeding（PPMB）, all-cause mortality and major adverse cardiac events（MACE） during 1 year follow-up were analyzed. Results PPMB occurred in 50 cases（1.3%） during 1 year follow-up. Female, baseline systolic blood pressure≤120 mmHg, baseline heart rate〉80 times/min, coronary revascularization history, peptic ulcer history, femoral artery puncture history, use of dual antiplatelet therapy＋glycoprotein Ⅱb/Ⅲa receptor antagonist＋low molecular heparin/fondaparinux antithrombotic therapy were independent risk factors of 1 year PPMB（P〈0.05）. PPMB was significantly correlated with 30 d, 1 year all-cause mortality and 30 d MACE（P〈0.05）. Conclusion The 1 year incidence of PPMB in patients with NSTE-ACS was 1.3%; bleeding-related adverse outcomes mostly occur during the first 30 days after PCI.