Duke Clinical Research Institute, Durham, North Carolina 27705, USA.
JACC Cardiovasc Interv. 2012 Sep;5(9):958-65. doi: 10.1016/j.jcin.2012.05.010.
The authors sought to describe the association between post-procedural bleeding and long-term recurrent bleeding, major adverse cardiac events (MACE), and mortality among older patients undergoing percutaneous coronary intervention (PCI).
Bleeding complications after PCI are associated with an increased risk for acute morbidity and long-term mortality, but the association of these bleeding complications with other events is unknown.
Patients entered into the National Cardiovascular Data Registry (NCDR) CathPCI Registry (n = 461,311; 946 sites) from January 2004 to December 2008 were linked with claims from the Centers for Medicare & Medicaid Services and grouped according to in-hospital post-PCI bleeding. The association between post-PCI bleeding and 1-, 12-, and 30-month readmission for bleeding, MACE, and all-cause mortality was examined with Cox regression that included patient and procedural characteristics using no bleeding as the reference.
Overall, 3.1% (n = 14,107) of patients experienced post-PCI bleeding. Patients who bled were older, more often female, had more medical comorbidities, less often received bivalirudin, and more often underwent PCI via the femoral approach. After adjustment, bleeding after the index procedure was significantly associated with readmission for bleeding (adjusted hazard ratios [95% confidence interval]: 1 month, 1.54 [1.42 to 1.67]; 12 months, 1.52 [1.40 to 1.66]; 30 months, 1.29 [1.11 to 1.50]), MACE (1 month, 1.11 [1.07 to 1.15]; 12 months, 1.17 [1.13 to 1.21]; 30 months, 1.12 [1.06 to 1.19]) and all-cause mortality (1 month, 1.32 [1.26 to 1.38]; 12 months, 1.33 [1.27 to 1.40]); 30 months, 1.22 [1.15 to 1.30]).
Post-PCI bleeding complications are associated with an increased risk for short- and long-term recurrent bleeding, MACE, and all-cause mortality. These data underscore the prognostic importance of periprocedural bleeding and the need for identifying strategies to reduce long-term bleeding risk among patients undergoing PCI.
本研究旨在描述老年经皮冠状动脉介入治疗（PCI）患者术后出血与长期复发性出血、主要不良心脏事件（MACE）和死亡率之间的关系。
PCI 后出血并发症与急性发病率和长期死亡率增加相关，但这些出血并发症与其他事件的关系尚不清楚。
本研究纳入 2004 年 1 月至 2008 年 12 月期间在国家心血管数据注册库（NCDR）CathPCI 注册库（n=461311；946 个中心）中登记的患者，并与医疗保险和医疗补助服务中心的索赔数据进行了关联，并根据住院期间 PCI 后的出血情况进行了分组。采用 Cox 回归分析，将患者和手术特征纳入其中，以无出血作为参考，评估 PCI 后出血与 1、12 和 30 个月时因出血、MACE 和全因死亡率而再次入院之间的关系。
总体而言，3.1%（n=14107）的患者发生了 PCI 后出血。出血患者年龄较大，女性较多，合并症较多，较少接受比伐卢定治疗，更多采用股动脉入路进行 PCI。经调整后，指数手术后出血与再次出血入院（校正后的危险比[95%置信区间]：1 个月 1.54[1.42 至 1.67]；12 个月 1.52[1.40 至 1.66]；30 个月 1.29[1.11 至 1.50]）、MACE（1 个月 1.11[1.07 至 1.15]；12 个月 1.17[1.13 至 1.21]；30 个月 1.12[1.06 至 1.19]）和全因死亡率（1 个月 1.32[1.26 至 1.38]；12 个月 1.33[1.27 至 1.40]；30 个月 1.22[1.15 至 1.30]）显著相关。
PCI 后出血并发症与短期和长期复发性出血、MACE 和全因死亡率增加相关。这些数据强调了围手术期出血的预后重要性，以及需要确定策略来降低接受 PCI 治疗的患者的长期出血风险。
