From the Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., J.P., M.R., A.S., J.N., R.B., M.A.M.); Academic Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom (C.S.K., A.S., J.N., M.A.M.); Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (E.K.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.).
Circ Cardiovasc Interv. 2018 Feb;11(2):e005866. doi: 10.1161/CIRCINTERVENTIONS.117.005866.
Retroperitoneal hemorrhage (RH) is a rare bleeding complication of percutaneous coronary intervention, which can result as a consequence of femoral access or can occur spontaneously. This study aims to evaluate temporal changes in RH, its predictors, and clinical outcomes in a national cohort of patients undergoing percutaneous coronary intervention in the United Kingdom.
We analyzed RH events in patients who underwent percutaneous coronary intervention between 2007 and 2014. Multiple logistic regression models were used to identify factors associated with RH and to quantify the association between RH and 30-day mortality and major adverse cardiovascular events. A total of 511 106 participants were included, and 291 in hospital RH events were recorded (0.06%). Overall, rates of RH declined from 0.09% to 0.03% between 2007 and 2014. The strongest independent predictors of RH events were femoral access (odds ratio [OR], 19.66; 95% confidence interval [CI], 11.22-34.43), glycoprotein IIb/IIIa inhibitor (OR, 2.63; 95% CI, 1.99-3.47), and warfarin use (OR, 2.53; 95% CI, 1.07-5.99). RH was associated with a significant increase in 30-day mortality (OR, 3.59; 95% CI, 2.19-5.90) and in-hospital major adverse cardiovascular events (OR, 5.76; 95% CI, 3.71-8.95). A legacy effect was not observed; patients with RH who survived 30 days did not have higher 1-year mortality compared with those without this complication (hazard ratio, 0.97; 95% CI, 0.49-1.91).
Our results suggest that RH is a rare event that is declining in the United Kingdom, related to transition to transradial access site utilization, but remains a clinically important event associated with increased 30-day mortality but no long-term legacy effect.
腹膜后出血（RH）是经皮冠状动脉介入治疗罕见的出血并发症，可由股动脉入路引起，也可自发性发生。本研究旨在评估英国全国经皮冠状动脉介入治疗患者队列中 RH 的时间变化、其预测因素以及临床结局。
我们分析了 2007 年至 2014 年间接受经皮冠状动脉介入治疗的患者的 RH 事件。使用多因素逻辑回归模型确定与 RH 相关的因素，并量化 RH 与 30 天死亡率和主要心血管不良事件之间的关联。共纳入 511106 例患者，记录了 291 例住院 RH 事件（0.06%）。总体而言，RH 发生率从 2007 年至 2014 年从 0.09%降至 0.03%。RH 事件的最强独立预测因素为股动脉入路（比值比 [OR]，19.66；95%置信区间 [CI]，11.22-34.43）、糖蛋白 IIb/IIIa 抑制剂（OR，2.63；95%CI，1.99-3.47）和华法林的使用（OR，2.53；95%CI，1.07-5.99）。RH 与 30 天死亡率显著增加相关（OR，3.59；95%CI，2.19-5.90）和住院期间主要心血管不良事件（OR，5.76；95%CI，3.71-8.95）。未观察到遗留效应；30 天存活的 RH 患者与无此并发症的患者相比，1 年死亡率无升高（风险比，0.97；95%CI，0.49-1.91）。
我们的结果表明，RH 是一种罕见的事件，在英国呈下降趋势，与向经桡动脉入路的转变有关，但仍然是一个与 30 天死亡率增加相关的重要临床事件，但无长期遗留效应。
