出血学术研究联合会（BARC）定义的出血并发症对 ST 段抬高型心肌梗死的预后价值：与 TIMI（心肌梗死溶栓治疗）、GUSTO（全球应用链激酶和组织型纤溶酶原激活剂开通闭塞冠状动脉）和 ISTH（国际血栓与止血学会）出血分类的比较。
The prognostic value of bleeding academic research consortium (BARC)-defined bleeding complications in ST-segment elevation myocardial infarction: a comparison with the TIMI (Thrombolysis In Myocardial Infarction), GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries), and ISTH (International Society on Thrombosis and Haemostasis) bleeding classifications.
机构信息
Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
出版信息
J Am Coll Cardiol. 2014 May 13;63(18):1866-75. doi: 10.1016/j.jacc.2014.01.069. Epub 2014 Mar 19.
OBJECTIVES
The aim of the present analysis was to compare 1-year mortality prediction of Bleeding Academic Research Consortium (BARC)-defined bleeding complications with existing bleeding definitions in patients with ST-segment elevation myocardial infarction (STEMI) and to investigate the prognostic value of the individual data elements of the bleeding classifications for 1-year mortality.
BACKGROUND
BARC recently proposed a novel standardized bleeding definition.
METHODS
The in-hospital occurrence of bleeding defined according to the BARC, TIMI (Thrombolysis In Myocardial Infarction), GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries), and ISTH (International Society on Thrombosis and Haemostasis) bleeding classifications was assessed in 2,002 STEMI patients undergoing primary percutaneous coronary intervention between January 1, 2003, and July 31, 2008.
RESULTS
BARC types 2, 3, 4, and 5 bleeding occurred in 4.4%, 14.2%, 1.4%, and 0.3% of patients, respectively. By multivariable analysis, GUSTO- and ISTH-defined bleeding was not significantly associated with 1-year mortality, whereas TIMI major and BARC type 3b or 3c bleeding conferred a 2-fold higher risk of 1-year mortality (hazard ratios [HRs]: 2.00 [95% confidence interval (CI): 1.32 to 3.01] and 1.84 [95% CI: 1.23 to 2.77], respectively). Data elements most strongly associated with mortality were a hemoglobin decrease ≥5 g/dl (HR: 1.94 [95% CI: 1.26 to 2.98]), the use of vasoactive agents for bleeding (HR: 2.01 [95% CI: 0.91 to 4.44]), cardiac tamponade (HR: 2.38 [95% CI: 0.56 to 10.1]), and intracranial hemorrhage (HRs for 1-year mortality were not computable because there was only 1 patient with intracranial bleeding).
CONCLUSIONS
Both the BARC and TIMI bleeding classification identified STEMI patients at risk of 1-year mortality.
目的
本分析旨在比较 Bleeding Academic Research Consortium（BARC）定义的出血并发症与 ST 段抬高型心肌梗死（STEMI）患者中现有出血定义在预测 1 年死亡率方面的差异，并探讨出血分类的个体数据元素对 1 年死亡率的预测价值。
背景
BARC 最近提出了一种新的标准化出血定义。
方法
在 2003 年 1 月 1 日至 2008 年 7 月 31 日期间接受直接经皮冠状动脉介入治疗的 2002 例 STEMI 患者中，评估根据 BARC、TIMI（血栓溶解治疗心肌梗死）、GUSTO（全球应用链激酶和组织纤溶酶原激活剂治疗闭塞性冠状动脉疾病）和 ISTH（国际血栓和止血学会）出血分类定义的住院期间出血情况。
结果
BARC 2、3、4 和 5 型出血分别发生在 4.4%、14.2%、1.4%和 0.3%的患者中。多变量分析显示，GUSTO 和 ISTH 定义的出血与 1 年死亡率无显著相关性，而 TIMI 主要出血和 BARC 3b 或 3c 型出血使 1 年死亡率增加 2 倍（危险比[HR]：2.00[95%置信区间（CI）：1.32 至 3.01]和 1.84[95%CI：1.23 至 2.77]）。与死亡率最密切相关的数据元素是血红蛋白下降≥5g/dl（HR：1.94[95%CI：1.26 至 2.98]）、出血时使用血管活性药物（HR：2.01[95%CI：0.91 至 4.44]）、心脏压塞（HR：2.38[95%CI：0.56 至 10.1]）和颅内出血（1 年死亡率的 HR 无法计算，因为只有 1 例颅内出血患者）。
结论
BARC 和 TIMI 出血分类都确定了 STEMI 患者有 1 年死亡率风险。
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