Department of Cardiology, Takaoka City Hospital, Takaoka, Japan.
Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
J Cardiol. 2019 Aug;74(2):116-122. doi: 10.1016/j.jjcc.2019.01.008. Epub 2019 Feb 8.
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.
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.
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.
Assessment of ABI provides useful information for predicting 30-day bleeding complications and long-term mortality in patients with ACS after PCI.
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。
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。
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。
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。
