Kharchenko M S, Érlikh A D, Gratsianskiĭ N A
Kardiologiia. 2012;52(2):12-7.
Risk factors of bleeding in acute coronary syndrome (ACS) were derived from data of clinical trials and registers with high proportion of invasively treated patients. Aim of this study was to elucidate factors associated with severe bleeding in patients with non ST-elevation (NSTE) ACS treated in a noninvasive hospital.
From November 2009 to April 2011 24 NSTEACS patients had severe GUSTO or TIMI bleeding. For each of these patients we selected 3 age matched controls without severe bleeding from hospital registry of ACS in which we included 25 consecutive patients each month during about the same period of time.
The group of patients with severe bleeding compared with control group (n = 72) had greater portions of patients with Killip class > or = 2 (50.0% vs 16.7%; p = 0.002), with history of chronic renal failure (20.8% vs 4.2%; p = 0.02) or bleeding (16.7 vs 2.8%, p = 0.03), with admission creatinine clearance < 30 (20.8% vs 5.6%; p = 0.04), with GRACE score > 140 (75.0 vs 45.8%, p = 0.01). Patients with bleeding prehospitally less frequently received aspirin (25.0 vs 58.3%, p = 0.005) and parenteral anticoagulants (16.7 vs 38.9%, p = 0.04), while in hospital they were more frequently given diuretics (62.5 and 26.4%, p = 0.005) and less frequently--low molecular weight heparin (8.3 vs 20.8%, p = 0.045) while use of parental anticoagulants was similar in both groups (87.5 vs 91.7%, respectively). Mortality and rate of inhospital myocardial infarctions in groups with and without bleeding were 62.5 and 1.4%, 21.7 and 1.4%, respectively.
Inhospital severe bleeding in noninvasively treated patients with NSTEACS was associated with: well known predictors (heart and renal failure, history of bleeding); high risk of ischemic events and therefore very high mortality; lesser use of some antithrombotic drugs at various stages of treatment.
急性冠状动脉综合征（ACS）出血的危险因素源自临床试验和登记数据，这些数据来自接受侵入性治疗患者比例较高的情况。本研究的目的是阐明在非侵入性医院接受治疗的非ST段抬高（NSTE）ACS患者中与严重出血相关的因素。
2009年11月至2011年4月，24例NSTEACS患者发生了严重的GUSTO或TIMI出血。对于这些患者中的每一位，我们从ACS医院登记册中为其选择3名年龄匹配且无严重出血的对照患者，该登记册在大约同一时期每月纳入25例连续患者。
与对照组（n = 72）相比，严重出血患者组中Killip分级>或= 2的患者比例更高（50.0%对16.7%；p = 0.002），有慢性肾衰竭病史的患者比例更高（20.8%对4.2%；p = 0.02）或有出血史的患者比例更高（16.7%对2.8%，p = 0.03），入院时肌酐清除率< 30的患者比例更高（20.8%对5.6%；p = 0.04），GRACE评分> 140的患者比例更高（75.0%对45.8%，p = 0.01）。院前出血的患者较少使用阿司匹林（25.0%对58.3%，p = 0.005）和胃肠外抗凝剂（16.7%对38.9%，p = 0.04），而在住院期间他们更频繁地使用利尿剂（62.5%和26.4%，p = 0.005）且较少使用低分子量肝素（8.3%对20.8%，p = 0.045），而两组中胃肠外抗凝剂的使用情况相似（分别为87.5%和91.7%）。有出血和无出血组的死亡率和院内心肌梗死发生率分别为62.5%和1.4%，21.7%和1.4%。
在接受非侵入性治疗的NSTEACS患者中，院内严重出血与以下因素相关：众所周知的预测因素（心力衰竭和肾衰竭、出血史）；缺血事件的高风险以及因此非常高的死亡率；在治疗的各个阶段某些抗血栓药物的使用较少。
