Brinkert Miriam, Southern Danielle A, James Matthew T, Knudtson Merrill L, Anderson Todd J, Charbonneau François
Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland.
O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Can J Cardiol. 2017 Aug;33(8):998-1005. doi: 10.1016/j.cjca.2017.05.001. Epub 2017 May 5.
Bleeding complications accompanying coronary revascularization are associated with increased mortality; however, few data are available on subsequent bleeding risk. We used administrative data to assess the incidence of late bleeding events in patients with acute coronary syndrome (ACS) according to treatment allocation.
The cohort and bleeding events were identified through the Canadian Institute for Health Information discharge abstract database. Crude and adjusted odds ratios (ORs) were calculated for index and postindex admission bleeding up to 1 year after discharge.
Of 31,941 patients hospitalized with ACS, 7681 (32.4%) patients were treated with medication alone, 3728 (15.2%) underwent angiography without intervention, and 13,075 (53.4%) underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The overall incidence of readmission with bleeding based on administrative codes was low (3.8% for medically treated patients, 2.8% for patients who underwent angiography alone, 2.6% for patients who underwent CABG, and 1.8% for patients who underwent PCI; P < 0.0001). Bleeding codes were mainly gastrointestinal bleeding (52%), but 7.8% were intracranial episodes of bleeding. Patients who received PCI had significantly lower odds of late bleeding compared with medically treated patients (OR, 0.76; 95% CI, 0.62-0.94). Late bleeding during the first year after ACS was associated with mortality (OR, 4.96; 95% CI, 2.47-9.93).
Patients who underwent revascularization procedures had a relatively low risk for late bleeding events after a hospitalization for ACS. Late bleeding events were associated with an increased risk of death.
冠状动脉血运重建伴随的出血并发症与死亡率增加相关；然而，关于后续出血风险的数据较少。我们使用管理数据根据治疗分配评估急性冠状动脉综合征（ACS）患者晚期出血事件的发生率。
通过加拿大卫生信息研究所出院摘要数据库确定队列和出血事件。计算出院后长达1年的索引入院和索引后入院出血的粗比值比（OR）和调整后的OR。
在31941例因ACS住院的患者中，7681例（32.4%）仅接受药物治疗，3728例（15.2%）接受了未进行干预的血管造影，13075例（53.4%）接受了经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）。基于管理代码的出血再入院总体发生率较低（药物治疗患者为3.8%，仅接受血管造影的患者为2.8%，接受CABG的患者为2.6%，接受PCI的患者为1.8%；P<0.0001）。出血代码主要为胃肠道出血（52%），但7.8%为颅内出血事件。与接受药物治疗的患者相比，接受PCI的患者晚期出血的几率显著较低（OR，0.76；95%CI，0.62-0.94）。ACS后第一年的晚期出血与死亡率相关（OR，4.96；95%CI，2.47-9.93）。
接受血运重建手术的患者在因ACS住院后发生晚期出血事件的风险相对较低。晚期出血事件与死亡风险增加相关。
