经皮冠状动脉介入治疗后穿刺部位与非穿刺部位出血及后续死亡风险和主要不良心血管事件：系统评价与荟萃分析
Access and non-access site bleeding after percutaneous coronary intervention and risk of subsequent mortality and major adverse cardiovascular events: systematic review and meta-analysis.
作者信息
Kwok Chun Shing, Khan Muhammad A, Rao Sunil V, Kinnaird Tim, Sperrin Matt, Buchan Iain, de Belder Mark A, Ludman Peter F, Nolan James, Loke Yoon K, Mamas Mamas A
机构信息
From the Cardiovascular Institute (C.S.K., M.A.M.), Institute of Population Health (M.S., I.B.), and Farr Institute (M.S., I.B., M.A.M.), University of Manchester, Manchester, United Kingdom; Manchester Heart Centre, Central Manchester NHS Foundation Trust, Manchester, Lancashire, United Kingdom (M.A.K., M.A.M.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.V.R.); Department of Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom (T.K.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, North Yorkshire, United Kingdom (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, University Hospital North Midlands, Stoke-on-Trent, Staffordshire, United Kingdom (J.N.); and Norwich Medical School, University of East Anglia, Norwich, Norfolk, United Kingdom (Y.K.L.).
出版信息
Circ Cardiovasc Interv. 2015 Apr;8(4). doi: 10.1161/CIRCINTERVENTIONS.114.001645.
BACKGROUND
The prognostic impact of site-specific major bleeding complications after percutaneous coronary intervention (PCI) has yielded conflicting data. The aim of this study is to provide an overview of site-specific major bleeding events in contemporary PCI and study their impact on mortality and major adverse cardiovascular event outcomes.
METHODS AND RESULTS
We conducted a meta-analysis of PCI studies that evaluated site-specific periprocedural bleeding complications and their impact on major adverse cardiovascular events and mortality outcomes. A systematic search of MEDLINE and Embase was conducted to identify relevant studies and random effects meta-analysis was used to estimate the risk of adverse outcomes with site-specific bleeding complications. Twenty-five relevant studies including 2,400,645 patients that underwent PCI were identified. Both non-access site (risk ratio [RR], 4.06; 95% confidence interval [CI], 3.21-5.14) and access site (RR, 1.71; 95% CI, 1.37-2.13) related bleeding complications were independently associated with an increased risk of periprocedural mortality. The prognostic impact of non-access site-related bleeding events on mortality related to the source of anatomic bleeding, for example, gastrointestinal RR, 2.78; 95% CI, 1.25 to 6.18; retroperitoneal RR, 5.87; 95% CI, 1.63 to 21.12; and intracranial RR, 22.71; 95% CI, 12.53 to 41.15.
CONCLUSIONS
The prognostic impact of bleeding complications after PCI varies according to anatomic source and severity. Non-access site-related bleeding complications have a similar prevalence to those from the access site but are associated with a significantly worse prognosis partly related to the severity of the bleed. Clinicians should minimize the risk of major bleeding complications during PCI through judicious use of bleeding avoidance strategies irrespective of the access site used.
背景
经皮冠状动脉介入治疗（PCI）后特定部位严重出血并发症的预后影响数据存在矛盾。本研究的目的是概述当代PCI中特定部位的严重出血事件，并研究它们对死亡率和主要不良心血管事件结局的影响。
方法和结果
我们对评估特定部位围手术期出血并发症及其对主要不良心血管事件和死亡率结局影响的PCI研究进行了荟萃分析。对MEDLINE和Embase进行了系统检索以识别相关研究，并使用随机效应荟萃分析来估计特定部位出血并发症的不良结局风险。确定了25项相关研究，包括2400645例接受PCI的患者。非穿刺部位（风险比[RR]，4.06；95%置信区间[CI]，3.21 - 5.14）和穿刺部位（RR，1.71；95%CI，1.37 - 2.13）相关的出血并发症均与围手术期死亡率增加独立相关。非穿刺部位相关出血事件对死亡率的预后影响与解剖学出血来源有关，例如，胃肠道RR，2.78；95%CI，1.25至6.18；腹膜后RR，5.87；95%CI，1.63至21.12；颅内RR，22.71；95%CI，12.53至41.15。
结论
PCI后出血并发症的预后影响因解剖学来源和严重程度而异。非穿刺部位相关出血并发症的发生率与穿刺部位相似，但预后明显更差，部分与出血严重程度有关。无论使用何种穿刺部位，临床医生都应通过明智地使用出血避免策略，将PCI期间严重出血并发症的风险降至最低。
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