经皮冠状动脉介入治疗后急性冠状动脉综合征患者踝臂指数降低对 30 天出血并发症和长期死亡率的影响。
Impact of decreased ankle-brachial index on 30-day bleeding complications and long-term mortality in patients with acute coronary syndrome after percutaneous coronary intervention.
机构信息
Department of Cardiology, Takaoka City Hospital, Takaoka, Japan.
Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
出版信息
J Cardiol. 2019 Aug;74(2):116-122. doi: 10.1016/j.jjcc.2019.01.008. Epub 2019 Feb 8.
BACKGROUND
Although concomitant peripheral artery disease in patients with acute coronary syndrome (ACS) has been considered as a high-risk subgroup with a greater incidence of bleeding after percutaneous coronary intervention (PCI), few data exist regarding the clinical utility of the ankle-brachial index (ABI) for predicting bleeding complications, which affects the subsequent outcome.
METHODS
Eight hundred and twenty-four consecutive patients with ACS who underwent PCI and ABI examination were analyzed retrospectively. Decreased-ABI was defined as ABI <0.9. The primary outcome was bleeding complications within 30 days, which was defined according to the Bleeding Academic Research Consortium classification grade ≥3. The secondary endpoint was all-cause death during follow-up.
RESULTS
Of the 824 patients with ACS, 137 (16.6%) exhibited decreased-ABI. The incidence of bleeding complications was significantly higher in patients with decreased-ABI, compared with the remaining patients (21.9% vs. 6.0%, p<0.001). In multivariate analysis, anemia [odds ratio (OR) 2.14], estimated glomerular filtration rate<60mL/min/1.73m (OR 2.14), femoral access (OR 3.31), use of an intra-aortic balloon pump (OR 3.16), and decreased-ABI (OR 2.58) were independent predictors of 30-day bleeding complications. Assigning 1 point for each variable, we developed a new bleeding risk score (range, 0-5). The area under the receiver-operating characteristic curve for the probability of 30-day bleeding for the new risk score was significantly superior than that of the traditional one (0.82 vs. 0.76, p<0.05). During the median 4-year follow-up, there were 98 incidents of all-cause death. Multivariate Cox-proportional hazard analysis revealed that decreased-ABI [hazard ratio (HR) 1.91, 95% confidence interval (CI) 1.15-3.13, p<0.05] and 30-day bleeding (HR 3.00, 95% CI 1.76-4.97, p<0.001) were associated with an increased risk of all-cause mortality.
CONCLUSIONS
Assessment of ABI provides useful information for predicting 30-day bleeding complications and long-term mortality in patients with ACS after PCI.
背景
尽管急性冠状动脉综合征（ACS）患者合并外周动脉疾病被认为是经皮冠状动脉介入治疗（PCI）后出血发生率较高的高危亚组，但关于踝臂指数（ABI）预测出血并发症的临床应用价值的数据较少，而出血并发症会影响患者的后续预后。
方法
回顾性分析了 824 例接受 PCI 和 ABI 检查的 ACS 连续患者。ABI 降低定义为 ABI<0.9。主要终点为 30 天内出血并发症，根据出血学术研究联合会（BARC）分级≥3 定义。次要终点为随访期间的全因死亡。
结果
824 例 ACS 患者中，137 例（16.6%）存在 ABI 降低。与其余患者相比，ABI 降低的患者出血并发症发生率明显更高（21.9% vs. 6.0%，p<0.001）。多变量分析显示，贫血（比值比[OR] 2.14）、估计肾小球滤过率<60mL/min/1.73m（OR 2.14）、股动脉入路（OR 3.31）、使用主动脉内球囊泵（OR 3.16）和 ABI 降低（OR 2.58）是 30 天出血并发症的独立预测因素。为每个变量赋值 1 分，我们制定了新的出血风险评分（范围 0-5 分）。新风险评分预测 30 天出血概率的受试者工作特征曲线下面积明显优于传统评分（0.82 与 0.76，p<0.05）。在中位 4 年随访期间，发生了 98 例全因死亡事件。多变量 Cox 比例风险分析显示，ABI 降低（风险比[HR] 1.91，95%置信区间[CI] 1.15-3.13，p<0.05）和 30 天出血（HR 3.00，95%CI 1.76-4.97，p<0.001）与全因死亡率增加相关。
结论
评估 ABI 可为 ACS 患者 PCI 后预测 30 天出血并发症和长期死亡率提供有用信息。
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