Department of Gastroenterology, Nanjing First Hospital Affiliated to Nanjing Medical University, 68, Changle Road, Nanjing 210006, China.
Clin Res Hepatol Gastroenterol. 2013 Dec;37(6):636-41. doi: 10.1016/j.clinre.2013.03.011. Epub 2013 May 16.
Current medical therapies for patients who have an acute coronary syndrome (ACS) focus on the coagulation cascade and platelet inhibition. These, coupled with early use of cardiac catheterization and revascularization, have decreased morbidity and mortality rates in patients who have acute ischemic heart disease with risk of bleeding.
The study aimed to determine the incidence of gastrointestinal bleeding after percutaneous coronary intervention (PCI). The effect of proton-pump inhibitor (PPI) treatment was also analyzed.
This case-control study evaluated gastrointestinal bleeding within a year of PCI for stable angina and acute coronary syndromes at Nanjing First Hospital between 2008 and 2011. Cases were identified and outcomes assessed using linkage analysis of data from cardiology and gastroenterology department databases. Analysis of the case and control groups for both risk and protective factors was performed using independent two-sample Student's t-test with Fisher's exact P value and logistic regression.
The incidence of gastrointestinal bleeding following PCI was 1.3% (35/2680 patients). The risk factors for gastrointestinal bleeding were advanced age, female gender, smoking, drinking, previous peptic ulcer and previous gastrointestinal bleeding. PPI use after PCI (P=0.000) was accompanied by a lower risk of gastrointestinal bleeding, with only a few cases of gastrointestinal bleeding events reported.
The incidence of gastrointestinal bleeding associated with the combination of aspirin and clopidogrel therapy was estimated to be 1.3%. Advanced age, being female, smokers, drinkers, previous peptic ulcer and previous gastrointestinal bleeding were significant independent risk factors. PPI for the prevention and treatment of gastrointestinal bleeding induced by the combination of aspirin and clopidogrel in patients after PCI was safe and effective.
目前针对急性冠状动脉综合征（ACS）患者的医学治疗方法侧重于凝血级联和血小板抑制。这些方法，再加上早期使用心脏导管插入术和血运重建术，已经降低了有出血风险的急性缺血性心脏病患者的发病率和死亡率。
本研究旨在确定经皮冠状动脉介入治疗（PCI）后胃肠道出血的发生率，并分析质子泵抑制剂（PPI）治疗的效果。
本病例对照研究评估了 2008 年至 2011 年期间在南京第一医院接受稳定型心绞痛和急性冠状动脉综合征 PCI 治疗的患者一年内的胃肠道出血情况。通过心内科和消化内科数据库的数据链接分析来确定病例，并使用独立双样本 t 检验、Fisher 确切概率法和逻辑回归分析对病例组和对照组进行风险和保护因素分析。
PCI 后胃肠道出血的发生率为 1.3%（35/2680 例患者）。胃肠道出血的危险因素包括高龄、女性、吸烟、饮酒、既往消化性溃疡和既往胃肠道出血史。PCI 后使用 PPI（P=0.000）与胃肠道出血风险降低相关，仅报告了少数胃肠道出血事件。
阿司匹林和氯吡格雷联合治疗相关的胃肠道出血发生率估计为 1.3%。高龄、女性、吸烟者、饮酒者、既往消化性溃疡和既往胃肠道出血史是显著的独立危险因素。PPI 用于预防和治疗 PCI 后阿司匹林和氯吡格雷联合治疗引起的胃肠道出血是安全有效的。
