PCI术后消化道出血患者发生心脏缺血事件的危险因素分析

Risk factors of cardiac ischemic events in patients with gastrointestinal bleeding after percutaneous coronary intervention

目的探讨经皮冠状动脉介入术(PCI)后双联抗血小板治疗(DAPT)致上消化道出血患者发生心脏缺血事件(CIE)的危险因素,为更好地管理此类患者提供指导。方法回顾性分析117例PCI后DAPT导致上消化道出血的患者,根据是否发生CIE分为:CIE组(32例)和非CIE组(85例),比较两组间临床资料的差异,分析PCI术后DAPT导致上消化道出血住院期间发生CIE的危险因素。结果入选的117例患者中32例发生CIE,较非CIE组年龄、男性、糖尿病史、合并有心力衰竭、胃溃疡病史、出血前DAPT时间、出血后停用DAPT时间、出血后单用氯吡格雷均有统计学差异(P<0.05);多因素Logistic回归分析结果显示:年龄(OR=2.245,95%CI:1.145~3.564)、男性(OR=1.148,95%CI:0.276~1.183)、糖尿病史(OR=2.227,95%CI:1.274~3.284)、合并心力衰竭(OR=0.524,95%CI:0.311~0.837)、胃溃疡病史(OR=0.651,95%CI:0.329~1.417)、出血后停用DAPT时间(OR=3.157,95%CI:1.462~8.917)均是PCI术后使用DAPT导致上消化道出血患者发生CIE的危险因素,而出血后单独使用氯吡格雷(OR=1.418,95%CI:1.216~1.635)是其保护因素。结论年龄、男性、糖尿病史、合并有心力衰竭、胃溃疡病史、出血后停用DAPT均是PCI后DAPT导致上消化道出血患者发生CIE的独立危险因素,而出血后单独使用氯吡格雷是其保护因素,为我们更好地管理此类患者提供了有力的参考。

Objective To investigate the risk factors of cardiac ischemic events （CIE） in patients with upper gastrointestinal bleeding （UGIB） induced by dual anti-platelet therapy （DAPT） after percutaneous coronary intervention （PCI）, and provide guidance for management the patients well. Methods The patients （n=117） with UGIB induced by DAPT after PCI were retrospectively analyzed, and divided, according to whether or not CIE onset, into CIE group （n=32） and non-CIE group （n=85）. The clinical data was compared between 2 groups, and risk factors of CIE were analyzed in patients with UGIB induced by DAPT after PCI in duration of hospital stay. Results In 117 patients, there were 32 offered from CIE. Age, male, diabetes history, complicated heart failure, gastric ulcer history, DAPT time before bleeding, stopping time of DAPT after bleeding and clopidogrel used singly after bleeding all had statistical difference between 2 groups （P〈0.05）. The results of multi-factor regression analysis showed that age （OR=2.245, 95%CI1.145~3.564）, male （OR=1.148, 95%CI： 0.276~1.183）, diabetes history （OR=2.227, 95%CI： 1.274~3.284）, complicated heart failure （OR=0.524, 95%CI： 0.311~0.837）, gastric ulcer history （OR=0.651, 95%CI： 0.329~1.417） and stopping time of DAPT after bleeding （OR=3.157, 95%CI： 1.462~8.917） were risk factors of CIE. Clopidogrel used singly after bleeding was a protective factor （OR=1.418, 95%CI： 1.216~1.635）. Conclusion Age, male, diabetes history, complicated heart failure, gastric ulcer history and stopping DAPT after bleeding are risk factors of CIE, and clopidogrel used singly after bleeding is a protective factor in patients with UGIB induced by DAPT after PCI, which provides good reference for management of this kind of patients.