Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
Icahn School of Medicine at Mount Sinai, New York, New York.
J Am Coll Cardiol. 2015 Sep 1;66(9):1036-45. doi: 10.1016/j.jacc.2015.06.1323.
The incidence, predictors, and prognostic impact of post-discharge bleeding (PDB) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation are unclear.
This study sought to characterize the determinants and consequences of PDB after PCI.
The prospective ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) study was used to determine the incidence and predictors of clinically relevant bleeding events occurring within 2 years after hospital discharge. The effect of PDB on subsequent 2-year all-cause mortality was estimated by time-adjusted Cox proportional hazards regression.
Among 8,582 "all-comers" who underwent successful PCI with DES in the ADAPT-DES study, PDB occurred in 535 of 8,577 hospital survivors (6.2%) at a median time of 300 days (interquartile range: 130 to 509 days) post-discharge. Gastrointestinal bleeding (61.7%) was the most frequent source of PDB. Predictors of PDB included older age, lower baseline hemoglobin, lower platelet reactivity on clopidogrel, and use of chronic oral anticoagulation therapy. PDB was associated with higher crude rates of all-cause mortality (13.0% vs. 3.2%; p < 0.0001). Following multivariable adjustment, PDB was strongly associated with 2-year mortality (hazard ratio [HR]: 5.03; p < 0.0001), with an effect size greater than that of post-discharge myocardial infarction (PDMI) (HR: 1.92; p = 0.009).
After successful PCI with DES in an unrestricted patient population, PDB is not uncommon and has a strong relationship with subsequent all-cause mortality, greater that that associated with PDMI. Efforts to reduce PDB may further improve prognosis after successful DES implantation. (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents [ADAPT-DES]; NCT00638794).
经皮冠状动脉介入治疗（PCI）置入药物洗脱支架（DES）后出院后出血（PDB）的发生率、预测因素和预后影响尚不清楚。
本研究旨在描述 PCI 后 PDB 的决定因素和后果。
前瞻性 ADAPT-DES（药物洗脱支架双联抗血小板治疗评估）研究用于确定 2 年内出院后发生临床相关出血事件的发生率和预测因素。采用时间调整 Cox 比例风险回归估计 PDB 对随后 2 年全因死亡率的影响。
在 ADAPT-DES 研究中，8582 例“所有患者”成功接受 PCI 并置入 DES，8577 例住院幸存者中有 535 例（6.2%）在出院后中位时间 300 天（四分位距：130 至 509 天）发生 PDB。胃肠道出血（61.7%）是 PDB 最常见的出血源。PDB 的预测因素包括年龄较大、基线血红蛋白较低、氯吡格雷血小板反应性较低以及使用慢性口服抗凝治疗。PDB 与较高的全因死亡率粗率相关（13.0% vs. 3.2%；p < 0.0001）。经多变量调整后，PDB 与 2 年死亡率强烈相关（风险比[HR]：5.03；p < 0.0001），其效应大小大于出院后心肌梗死（PDMI）（HR：1.92；p = 0.009）。
在不受限制的患者人群中成功接受 PCI 并置入 DES 后，PDB 并不少见，与随后的全因死亡率密切相关，与 PDMI 相关的死亡率更大。减少 PDB 的努力可能会进一步改善 DES 植入后的预后。（药物洗脱支架双联抗血小板治疗评估[ADAPT-DES]；NCT00638794）。
