Chin Marcus W S, Yong Gerald, Bulsara Max K, Rankin Jamie, Forbes Geoffrey M
Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia.
Am J Gastroenterol. 2007 Nov;102(11):2411-6. doi: 10.1111/j.1572-0241.2007.01460.x. Epub 2007 Sep 10.
Hemorrhagic complications of acute coronary syndromes and percutaneous coronary intervention (PCI) are associated with increased mortality. Upper gastrointestinal (UGI) bleeding after PCI is a potential target for preventative strategies.
To evaluate the risk factors for UGI bleeding in a large cohort of contemporary PCI patients and assess the outcomes of medical and endoscopic management.
A case-control study evaluating UGI bleeding in the 30 days following PCI for stable angina and acute coronary syndromes, at one institution between 1998 and 2005. Cases were identified and outcomes assessed using linkage analysis of data from institutional PCI and endoscopy databases, statewide vital statistics and hospital discharge registries, and a detailed review of medical notes for each case and three matched controls. Analysis of the case and control groups for risk and protective factors was performed using the chi2 test with Fisher's exact P value and logistic regression.
The incidence of UGI bleeding following PCI was 1.2% (70 of 5,673 patients). The etiologies of these bleeds were diverse. Risk factors for UGI bleeding were primary PCI (OR 27.80, 95% CI 6.28-123.05, P < 0.001), cardiac arrest (OR 6.17, 95% CI 1.82-20.84, P= 0.003), inotropic requirement (OR 5.85, 95% CI 1.98-17.27, P= 0.001), thienopyridine use before PCI (OR 2.40, 95% CI 1.04-5.53, P= 0.02), and advanced age (OR 1.08, 95% CI 1.04-1.12, P < 0.001). Proton pump inhibitor use after PCI (OR 0.08, 95% CI 0.02-0.40, P= 0.002) was accompanied by a reduced risk of UGI bleeding. Endoscopy provided therapeutic intervention in 33% of patients. There were no serious complications of endoscopy. The 30-day mortality for cases was 11.9% and 0.5% for controls (P= 0.001).
UGI bleeding after PCI is relatively common and associated with increased mortality. Those undergoing PCI for acute myocardial infarction or in the presence hemodynamic instability are at highest risk. Proton pump inhibition following PCI may reduce the bleeding risk, though when UGI bleeding occurs, therapeutic endoscopy is safe.
急性冠状动脉综合征及经皮冠状动脉介入治疗（PCI）的出血并发症与死亡率增加相关。PCI术后上消化道（UGI）出血是预防策略的一个潜在目标。
评估一大批当代PCI患者发生UGI出血的危险因素，并评估药物及内镜治疗的效果。
一项病例对照研究，于1998年至2005年在一家机构评估PCI治疗稳定型心绞痛和急性冠状动脉综合征后30天内的UGI出血情况。通过机构PCI和内镜数据库、全州生命统计数据和医院出院登记数据的关联分析，以及对每个病例和三个匹配对照的病历详细审查来确定病例并评估结果。使用卡方检验及Fisher精确P值和逻辑回归对病例组和对照组的风险及保护因素进行分析。
PCI术后UGI出血的发生率为1.2%（5673例患者中的70例）。这些出血的病因多种多样。UGI出血的危险因素包括直接PCI（比值比[OR]27.80，95%置信区间[CI]6.28 - 123.05，P < 0.001）、心脏骤停（OR 6.17，95% CI 1.82 - 20.84，P = 0.003）、需要使用血管活性药物（OR 5.85，95% CI 1.98 - 17.27，P = 0.001）、PCI术前使用噻吩并吡啶类药物（OR 2.40，95% CI 1.04 - 5.53，P = 0.02）以及高龄（OR 1.08，95% CI 1.04 - 1.12，P < 0.001）。PCI术后使用质子泵抑制剂（OR 0.08，95% CI 0.02 - 0.40，P = 0.002）可降低UGI出血风险。33%的患者接受了内镜治疗干预。内镜检查无严重并发症。病例组的30天死亡率为11.9%，对照组为0.5%（P = 0.001）。
PCI术后UGI出血相对常见且与死亡率增加相关。因急性心肌梗死接受PCI或存在血流动力学不稳定的患者风险最高。PCI术后使用质子泵抑制剂可能降低出血风险，不过当发生UGI出血时，治疗性内镜检查是安全的。
