既往出血性脑卒中患者行经皮冠脉介入治疗后不良事件的危险因素分析

Analysis of risk factors for adverse prognosis in patients with previous hemorrhagic stroke undergoing percutaneous coronary intervention

目的分析既往出血性脑卒中患者发生急性冠脉综合征进行冠状动脉介入治疗(PCI)后发生不良心脑血管事件的危险因素。方法回顾性入选2010年1月至2023年6月天津健康医疗大数据超级平台内天津市72家二、三级医院住院且接受PCI的患者。其中既往有出血性脑卒中病史患者2015例,作为研究组;无此类病史患者218504例,作为对照组,收集研究人群的随访数据。主要研究终点为出血性脑卒中;次要终点包括全因死亡、急性心肌梗死及缺血性脑卒中。对研究人群进行分组后,采用χ^(2)检验比较2组人群在第1个月、第3个月、第6个月、1年内、2年内以及随访期内的所有终点事件的发病率。应用多因素Cox回归评价2组结局事件的风险比(HR)及95%置信区间(95%CI)。结果2组患者的基线特征包括年龄、性别、既往病史方面差异均具有统计学意义(P均<0.05)。对2组人群的不良事件进行分析显示,研究组主要终点事件(出血性脑卒中)发生率(4.22%vs 0.76%),以及次要终点全因死亡(10.20%vs 6.59%)、缺血性脑卒中(58.60%vs 15.30%)及急性心肌梗死(6.80%vs 5.38%)发生率均高于对照组,差异具有统计学意义(χ^(2)=304.48、40.81、2824.19、200.80,P<0.001、<0.001、<0.001、=0.006)。经多因素Cox回归分析后发现,多个临床病史及特征能预测PCI后出血性脑卒中的发生,包括既往出血性脑卒中(HR=6.092,95%CI:4.875~7.612,P<0.001)、年龄(HR=1.018,95%CI:1.013~1.023,P<0.001)、男性(HR=1.229,95%CI:1.127~1.381,P<0.001)、高血压(HR=1.223,95%CI:1.111~1.369,P<0.001)、心房颤动(HR=1.132,95%CI:1.023~1.252,P<0.001)、慢性肾功能不全(HR=1.535,95%CI:1.292~1.824,P<0.001)。结论既往有出血性脑卒中病史的急性冠脉综合征患者PCI后发生主要不良心脑血管事件风险高,男性、年龄、高血压、心房颤动病史以及慢性肾脏病是PCI术后再发脑出血的独立危险因素。

Objective To analyze the risk factors for major adverse cardiovascular and cerebrovascular events in patients with a history of hemorrhagic stroke who undergo percutaneous coronary intervention(PCI)for acute coronary syndrome(ACS),providing a basis for improving their prognosis.Methods Data for this study were obtained from the Tianjin Health Medical Big Data Super Platform,retrospectively selecting patients admitted to 72 secondary and tertiary hospitals in Tianjin City from January 2010 to June 2023 who underwent PCI.Among them,2015 patients with a history of hemorrhagic stroke were included as the study group;218504 patients without such history were included as the control group,and the study population was followed up.The primary endpoint was hemorrhagic stroke;secondary endpoints included all-cause death,acute myocardial infarction,and ischemic stroke.After dividing the study population,the incidence rates of all endpoint events during the first month,third month,sixth month,within one year,within two years,and throughout the follow-up period were compared between the two groups.Multivariate Cox regression was used to evaluate the hazard ratio(HR)and 95%confidence interval(95%CI)of outcome events between the two groups.Results The baseline characteristics of the two patient groups,including past medical history,showed significant differences Analysis of adverse events in the two groups revealed that compared to the control group,the study group had significantly higher incidence rates not only for the primary endpoint of hemorrhagic stroke(4.22%vs 0.76%,χ^(2)=304.48,P<0.001)but also for the secondary endpoints of all-cause death(10.20%vs 6.59%,χ^(2)=40.81,P<0.001),ischemic stroke(58.60%vs 15.30%,χ^(2)=2824.19,P<0.001),and acute myocardial infarction(6.80%vs 5.38%,χ^(2)=200.80,P=0.006).Multivariate Cox regression analysis identified several clinical histories and characteristics that could predict the occurrence of hemorrhagic stroke after PCI,including previous hemorrhagic stroke(HR=6.092,95%CI:4.875-7.612,P<0.001),age(HR=1.018,95%CI:1.013-1.023,P<0.001),male gender(HR=1.229,95%CI:1.127-1.381,P<0.001),hypertension(HR=1.223,95%CI:1.111-1.369,P<0.001),atrial fibrillation(HR=1.132,95%CI:1.023-1.252,P<0.001),and chronic renal insufficiency(HR=1.535,95%CI:1.292-1.824,P<0.001).Conclusion ACS patients with a history of hemorrhagic stroke have a high risk of major adverse cardiovascular and cerebrovascular events after PCI,with male gender,age,hypertension,atrial fibrillation,and chronic kidney disease being independent risk factors for the recurrence of hemorrhagic stroke post-PCI.