急性心肌梗死患者溶栓后出血预测因素分析

Predictors of Bleeding in ST-segment Elevation Acute Myocardial Infarction Patients With Fibrinolysis Therapy

目的:了解急性ST段抬高型心肌梗死(STEMI)患者接受溶栓治疗后的出血发生率,并探讨出血相关的预测因素。方法:2013-01至2014-06纳入中国急性心肌梗死(CAMI)注册研究中1 568例行溶栓治疗的急性STEMI患者,了解其溶栓后出血发生率,并根据出血情况,分为出血组(n=55)和未出血组(n=1 513),同时利用Logistic多元回归模型分析出血相关因素。结果:1 568例急性STEMI患者溶栓后,临床判断溶栓成功率为86%,出血发生率为3.5%,其中脑出血发生率为0.6%,消化道出血为1.9%。与未出血组相比,出血组溶栓成功率高,趋近统计学差异(94.1%vs 85.7%,P=0.0589),死亡率明显较高(20.0%vs 7.1%,P=0.0019)。Logistic多元回归分析显示,高龄(≥75岁)(OR=2.45,95%CI:1.10～5.46,P=0.0290),和使用重组组织型纤溶酶原激活剂(rtPA)(OR=3.41,95%CI:1.48～7.86,P=0.0040)是院内溶栓出血的独立预测因素。结论:中国急性STEMI患者溶栓合并出血事件率较低,高龄与使用rtPA是出血的独立预测因素。

Objectives： To observe the prevalence of bleeding and to explore the independent predictors of bleeding in ST-segment elevation acute myocardial infarction patients with fibrinolysis therapy in China. Methods： From January 2013 to June 2014, 1 568 patients undergoing fibrinolysis in the Chinese Acute Myocardial Infarction Registry （CAMI） were prospectively included. Patients were divided into bleeding group （bleeding after fibrinolysis, n=55） and no bleeding group （without bleeding after fibrinolysis, n=l 513）. Logistic regression analysis was performed to define the independent predictors of bleeding. Results： The prevalence of bleeding with fibrinolysis in these patients was 3.5% （55/1 568）. The fibrinolysis success rate is 86%. Among them, the rate of intracranial bleeding was 0.6%, and the rate of gastrointestinal bleeding was 1.9%. The fibrinolysis success tended to be higher in patients with bleeding （94.1% vs 85.7%, P=0.0589） ,and the mortality rate was significantly higher in patients with bleeding （20.0% vs 7.1%, P=0.0019）. Logistic regression analysis showed that age〉75 years （OR=2.45, 95%CI： 1.10-5.46, P=-0.0290） and use of rtPA （HR=3.41, 95%CI： 1.48-7.86, P=0.0040） were independent predictors of bleeding after fibrinolysis in this patient cohort. Conclusions： The prevalence of bleeding after fibrinolysis in Chinese STEMI patients is low. Older age and rtPA use are independent predictors of bleeding after fibrinolysis in this patient cohort.