Alaa El Din Abbass, Debeaumarche Hugo, Thouant Pierre, Maza Maud, Ricolfi Frédéric, Zeller Marianne, Bichat Florence, Baudouin Nathalie, Bejot Yannick, Cottin Yves
University Hospital Center Dijon Bourgogne, Cardiology Department, Dijon, France.
University Hospital Center Dijon Bourgogne, Neuroradiology Department, Dijon, France.
Int J Cardiol Heart Vasc. 2020 May 29;28:100531. doi: 10.1016/j.ijcha.2020.100531. eCollection 2020 Jun.
Cerebral microbleeds (CMB) are associated with intracerebral haemorrhage. Therefore they may represent a concern if anticoagulant and/or antiplatelet therapy is needed. The aim of this study was to determine the prevalence of CMB in patients with acute myocardial infarction (AMI), and to follow their progression at 3 months under dual antiplatelet therapy (DAPT).
This prospective study included patients aged over 60 hospitalized in intensive cardiac care unit in our city for AMI. These patients underwent a first brain Magnetic resonance imaging (MRI) within 72 h of admission, that was repeated 3 months.
108 patients were included between November 2016 and December 2018. The prevalence of CMB was 21.3%, with a female predominance of 65.2% vs 32.1% (p = 0.004). Diabetes is significantly associated with the presence of CMB, 45.5% vs 21.2% (p = 0.021). Patients with at least one acute CMB had higher haemorrhagic risk as evaluated with CRUSADE score (40.5 ± 13.6 vs 31.2 ± 14.8 (p = 0.004).Multivariate analysis showed that only female sex was associated with the presence of a CMB on the initial MRI. On repeated MRI, an increase in CMB was observed in 6% of patients.Our results suggest that discharge treatment with anticoagulant in combination with antiplatelet therapy may be an independent predictor of early progression of CMB.
Our study confirms the high prevalence of CMB in patients over 60 years with AMI. The association of anticoagulant with DAPT, 3 months after stenting, may be an independent factor of CMB progression.
脑微出血（CMB）与脑出血相关。因此，如果需要抗凝和/或抗血小板治疗，它们可能会引起关注。本研究的目的是确定急性心肌梗死（AMI）患者中CMB的患病率，并在双重抗血小板治疗（DAPT）下随访其3个月时的进展情况。
这项前瞻性研究纳入了我市重症心脏监护病房因AMI住院的60岁以上患者。这些患者在入院72小时内接受了首次脑部磁共振成像（MRI）检查，并在3个月后重复检查。
2016年11月至2018年12月期间共纳入108例患者。CMB的患病率为21.3%，女性占优势，为65.2%，而男性为32.1%（p = 0.004）。糖尿病与CMB的存在显著相关，分别为45.5%和21.2%（p = 0.021）。至少有一处急性CMB的患者，用CRUSADE评分评估出血风险更高（40.5±13.6对31.2±14.8，p = 0.004）。多变量分析显示，只有女性性别与初始MRI上CMB的存在相关。在重复MRI检查时，6%的患者CMB有所增加。我们的结果表明，出院时联合使用抗凝剂和抗血小板治疗可能是CMB早期进展的独立预测因素。
我们的研究证实60岁以上AMI患者中CMB的患病率很高。支架置入3个月后，抗凝剂与DAPT联合使用可能是CMB进展的独立因素。
