Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, 4401 Wornall Rd, Kansas City, MO 64111, USA.
JAMA. 2010 Jun 2;303(21):2156-64. doi: 10.1001/jama.2010.708.
Bleeding complications with percutaneous coronary intervention (PCI) are associated with adverse patient outcomes. The association between the use of bleeding avoidance strategies and post-PCI bleeding as a function of a patient's preprocedural risk of bleeding is unknown.
To describe the use of 2 bleeding avoidance strategies, vascular closure devices and bivalirudin, and associated post-PCI bleeding rates in a nationally representative PCI population.
DESIGN, SETTING, AND PATIENTS: Analysis of data from 1,522,935 patients undergoing PCI procedures performed at 955 US hospitals participating in the National Cardiovascular Data Registry (NCDR) CathPCI Registry from January 1, 2004, through September 30, 2008.
Periprocedural bleeding.
Bleeding occurred in 30,654 patients (2%). Manual compression, vascular closure devices, bivalirudin, or vascular closure devices plus bivalirudin were used in 35%, 24%, 23%, and 18% of patients, respectively. Bleeding events were reported in 2.8% of patients who received manual compression, compared with 2.1%, 1.6%, and 0.9% of patients receiving vascular closure devices, bivalirudin, and both strategies, respectively (P < .001). Bleeding rates differed by preprocedural risk assessed with the NCDR bleeding risk model (low risk, 0.72%; intermediate risk, 1.73%; high risk, 4.69%). In high-risk patients, use of both strategies was associated with lower bleeding rates (manual compression, 6.1%; vascular closure devices, 4.6%; bivalirudin, 3.8%; vascular closure devices plus bivalirudin, 2.3%; P < .001). This association persisted following adjustment using a propensity-matched and site-controlled model. Use of both strategies was used least often in high-risk patients (14.4% vs 21.0% in low-risk patients, P < .001).
In a large national PCI registry, vascular closure devices and bivalirudin were associated with significantly lower bleeding rates, particularly among patients at greatest risk for bleeding. However, these strategies were less often used among higher-risk patients.
经皮冠状动脉介入治疗（PCI）相关的出血并发症与患者预后不良有关。患者术前出血风险与使用出血预防策略和 PCI 后出血之间的关系尚不清楚。
描述在一个全国性的 PCI 人群中，使用 2 种出血预防策略（血管闭合装置和比伐卢定）的情况，以及相关的 PCI 后出血发生率。
设计、地点和患者：分析 2004 年 1 月 1 日至 2008 年 9 月 30 日期间，在美国 955 家参与国家心血管数据注册（NCDR）CathPCI 注册的医院中，接受 PCI 治疗的 1522935 例患者的数据。
围手术期出血。
30654 例患者（2%）发生出血。分别有 35%、24%、23%和 18%的患者接受了手动压迫、血管闭合装置、比伐卢定或血管闭合装置加比伐卢定治疗。接受手动压迫的患者中有 2.8%报告了出血事件，而接受血管闭合装置、比伐卢定和两种策略的患者分别有 2.1%、1.6%和 0.9%（P <.001）。根据 NCDR 出血风险模型评估的术前风险，出血率不同（低危患者为 0.72%，中危患者为 1.73%，高危患者为 4.69%）。在高危患者中，同时使用两种策略与较低的出血率相关（手动压迫为 6.1%，血管闭合装置为 4.6%，比伐卢定为 3.8%，血管闭合装置加比伐卢定为 2.3%；P <.001）。这种关联在使用倾向匹配和地点控制模型进行调整后仍然存在。在高危患者中，同时使用两种策略的比例最低（低危患者为 21.0%，高危患者为 14.4%，P <.001）。
在一个大型的全国性 PCI 注册研究中，血管闭合装置和比伐卢定与显著较低的出血率相关，尤其是在出血风险最高的患者中。然而，这些策略在高危患者中使用得较少。
