The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
Division of Cardiology, Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy.
Thromb Haemost. 2018 Nov;118(11):1997-2005. doi: 10.1055/s-0038-1673687. Epub 2018 Oct 12.
Although several variables have been identified as bleeding determinants (BDs), their occurrence and predictive value in patients undergoing percutaneous coronary intervention (PCI) in the real world remain unclear. We aimed to characterize the rate of BDs in patients undergoing PCI with stent implantation in a large volume tertiary centre.
We included patients undergoing coronary stenting at our institution from January 2012 to December 2016, and defined post-discharge bleeding (PDB) as bleeding requiring hospitalization or transfusion. Several BDs, identified by the PARIS bleeding and PRECISE-DAPT scores and inclusion criteria of the LEADERS FREE trial, were analysed.
In a population of 10,406 subjects who underwent PCI, 2,938 patients (28.2%) had 1, 2,367 (22.8%) had 2 and 2,913 (28.0%) had ≥3 pre-specified BD. Compared with patients without PDB, subjects who experienced PDB were older (70.43 ± 11.94 vs. 65.90 ± 11.54 years, < 0.0001) with a higher prevalence of common cardiovascular risk factors. One-year PDB occurred in 177 patients (2.4%), and consistently increased according to the number of BDs involved (1.12, 2.11 and 4.35%, respectively; < 0.0001). Analogously, 1-year rates of post-discharge myocardial infarction or stent thrombosis increased according to the number of BDs (2.44, 3.38 and 4.87%, respectively; < 0.0001). Only 7 BDs remained independently associated with PDB at 1 year, with anaemia, oral anticoagulant at discharge and malignancy representing the strongest predictors of such risk.
Many risk factors predispose to PDB; they were often clustered together and conferred additive PDB risk at 1-year of follow-up.
尽管已经确定了几个变量作为出血决定因素（BDs），但它们在现实世界中接受经皮冠状动脉介入治疗（PCI）的患者中的发生和预测价值仍不清楚。我们的目的是描述在大型三级中心接受支架植入 PCI 的患者中 BDs 的发生率。
我们纳入了 2012 年 1 月至 2016 年 12 月期间在我们机构接受冠状动脉支架植入术的患者，并将出院后出血（PDB）定义为需要住院或输血的出血。通过 PARIS 出血和 PRECISE-DAPT 评分以及 LEADERS FREE 试验的纳入标准，分析了几个 BDs。
在接受 PCI 的 10406 例患者中，2938 例患者（28.2%）有 1 个，2367 例患者（22.8%）有 2 个，2913 例患者（28.0%）有≥3 个预先指定的 BDs。与无 PDB 的患者相比，发生 PDB 的患者年龄较大（70.43±11.94 vs. 65.90±11.54 岁，<0.0001），且常见心血管危险因素的发生率更高。177 例患者（2.4%）发生 1 年 PDB，且发生率随 BDs 数量的增加而持续增加（分别为 1.12%、2.11%和 4.35%，<0.0001）。类似地，根据 BDs 数量，1 年后发生的出院后心肌梗死或支架血栓形成的发生率也相应增加（分别为 2.44%、3.38%和 4.87%，<0.0001）。只有 7 个 BDs 在 1 年内仍与 PDB 独立相关，贫血、出院时口服抗凝剂和恶性肿瘤是这种风险的最强预测因素。
许多危险因素易导致 PDB；它们通常聚集在一起，并在 1 年的随访中增加了 PDB 的风险。
