摘要
目的 探讨真实世界中国老年急性冠状动脉综合征(ACS)患者行冠状动脉介入(PCI)术后出血、血栓及净不良临床事件的发生率及其相关影响因素。方法 本研究是对《评估行PCI治疗的中国急性冠状动脉综合征患者出血风险的非干预性临床研究(BRIC研究)》的回顾性数据分析。连续纳入全国30家三级医院自2014年5月~2016年1月以及自2017年11月~2020年4月行PCI治疗的ACS患者,根据患者年龄是否≥65岁分为老年组和对照组,比较两组患者出院后1年内发生出血学术研究联盟(BARC)≥2型出血、主要不良心血管事件(MACE)以及净不良临床事件(NACE)的发生率,并通过COX回归分析进一步探索老年患者发生NACE的危险因素。结果 本研究最终纳入3 126例老年组患者和4 405例对照组患者。老年组患者PCI术后1年BARC≥2出血发生率为6.1%(n=190),与对照组患者(n=225,5.1%)比较,差异无统计学意义(χ^(2)=3.306,P=0.069)。MACE发生率明显高于对照组患者(4.9%vs. 1.8%),NACE发生率也明显增高(10.6%vs. 6.8%),差异有统计学意义(χ^(2)=56.831、33.999,P<0.05)。多因素COX回归分析显示慢性肾功能不全、临床表现为心肌梗死、以及抗栓用药策略是老年ACS患者发生NACE的独立危险因素(P<0.05)。结论 中国老年ACS患者PCI术后MACE事件发生率显著升高,综合BARC≥2出血后的净不良事件发生率也显著升高,慢性肾功能不全、临床表现为心肌梗死、以及抗栓用药策略是老年ACS患者院外1年发生NACE的独立危险因素。
Objective To investigate the incidence and related influencing factors of bleeding,thrombosis,and net adverse clinical events(NACE)in elderly Chinese patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods This study is a post-hoc analysis of the Beijing Risk Intervention Clinical Study(BRIC Study).Patients with ACS who underwent PCI treatment at 30 tertiary hospitals nationwide from May 2014 to January 2016 and from November 2017 to April 2020 were consecutively enrolled.Patients were divided into an elderly group(age≥65 years)and a control group,and the incidence rates of Bleeding Academic Research Consortium(BARC)≥2 bleeding,major adverse cardiovascular events(MACE),and NACE within one year after discharge were compared between the two groups.Cox regression analysis was performed to explore the risk factors for NACE in elderly patients.Results A total of 3126 elderly patients and 4405 control patients were included.The incidence of BARC≥2 bleeding one year after PCI was 6.1%(n=190)in elderly ACS patients,which was comparable to the control group(n=225,5.1%)(χ^(2)=3.306,P=0.069).The incidence of MACE was 4.9%,significantly higher than that in the control group(1.8%)(χ^(2)=56.831,P=0.000).The incidence of NACE was also significantly increased(10.6%vs.6.8%)(χ^(2)=33.999,P=0.000).Multivariate Cox regression analysis revealed that chronic renal insufficiency,clinical manifestations of myocardial infarction,and antithrombotic medication strategy were independent risk factors for NACE in elderly ACS patients(P<0.05).Conclusion The incidence of MACE significantly increases in elderly Chinese ACS patients after PCI,and the incidence of NACE,considering BARC≥2 bleeding,also significantly rises.Chronic renal insufficiency,clinical manifestations of myocardial infarction,and antithrombotic medication strategy are independent risk factors for NACE in elderly ACS patients one year after hospital discharge.
作者
李丹丹
于亚妮
庹潇丹
单冬凯
汪晶晶
陈韵岱
Li Dandan;Yu Yani;Tuo Xiaodan;Shan Dongkai;Wang Jingjing;Chen Yundai(Department of Cardiology,the Six Medical Center,Chinese PLA General Hospital,Beijing 100048,China)
出处
《中华保健医学杂志》
2025年第2期281-285,共5页
Chinese Journal of Health Care and Medicine
