摘要
目的分析急性ST段抬高型心肌梗死(STEMI)接受急症冠状动脉介入治疗(PCI)后发生严重出血患者的临床预后。方法回顾性分析2004年1月至2008年1月间412例急性STEMI接受急症PCI患者资料。比较严重出血患者(严重出血组)和其他患者(对照组)住院期间和术后1年主要心脏不良事件(MACE,包括死亡、再次心肌梗死和靶血管再次血运重建率)的发生率。结果与对照组比较,严重出血组年龄较大[(70±9)岁比(65±13)岁,P=0.04],女性多见(51.9%比23.1%,P<0.01)、血小板Ⅱb/Ⅲa受体拮抗剂(88.9%比69.4%,P=0.03)及主动脉内球囊反搏泵(7.4%比1.3%,P=0.02)使用率增加;住院期间和1年临床MACE发生率增高(分别为18.5%比5.7%,P=0.008;37.0%比14.3%,P=0.002)。多因素分析表明,年龄>70岁、女性、应用血小板Ⅱb/Ⅲa受体拮抗剂是发生严重出血的独立预测因素;严重出血是术后1年发生MACE的独立预测因素(OR:2.79,95%CI:2.21～5.90,P<0.01)。结论急性STEMI患者急症PCI并发严重出血患者术后1年MACE发生率显著增高,女性、高龄和应用血小板Ⅱb/Ⅲa受体拮抗剂是发生严重出血的独立预测因素。
Objective To evaluate the clinical outcomes of patients complicated with major bleeding after primary coronary intervention（PCI） for acute ST-segment elevation myocardial infarction（STEMI）.Methods During the period of January 2004-January 2008,primary PCI was performed in 412 consecutive patients with acute STEMI at Shanghai Ruijin Hospital.The clinical data were retrospectively analyzed.Major adverse cardiac events（MACE）,including death,reoccurrence of myocardial infarction and target vessel revascularization,in patients with major bleeding were compared with that in patients without major bleeding.Results Compared to patients without bleeding,the patients with bleeding were older（70.0 ± 8.9 years vs 64.9 ± 12.7 years,P = 0.04）,mainly the females（51.9% vs 23.1%,P = 0.001） and treated more often with glycoprotein（GP） Ⅱb / Ⅲa receptor inhibitor（88.9% vs 69.4%,P = 0.03） or intra-aortic balloon pump（7.4% vs 1.3%,P = 0.02）.In-hospital and one-year MACE rate in the patients with bleeding was 18.5% and 37.0% respectively,which were significantly higher than that in the patients without bleeding（5.7% and 14.3%,with P = 0.008 and P = 0.002,respectively）.Multivariate analysis indicated that patient aged over 70 years,feminine gender and use of GP Ⅱb / Ⅲa receptor inhibitor were independent predictors for the occurrence of major bleeding.The occurrence of major bleeding after primary PCI was significantly correlated with MACE occurred within one year after the procedure（OR 2.79,95% CI： 2.21-5.90,P 〈 0.001）.Conclusion In patients with acute STEMI,the occurrence of major bleeding after primary PCI is closely linked to the increased MACE rate within one year after the treatment.Feminine gender,aged patient and use of GPⅡb / Ⅲa receptor inhibitor are independent predictors to increase the danger of major bleeding.
出处
《介入放射学杂志》
CSCD
北大核心
2009年第11期808-811,共4页
Journal of Interventional Radiology
基金
上海市科委重大课题研究资助05DZ19503
