Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Am J Cardiol. 2021 Jun 1;148:1-7. doi: 10.1016/j.amjcard.2021.02.027. Epub 2021 Mar 3.
Major adverse cardiac event (MACE) and bleeding risks following percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) are not well defined in individuals with heart failure (HF). We followed 1,145 individuals in the Pharmacogenomic Resource to improve Medication Effectiveness Genotype Guided Antiplatelet Therapy cohort for MACE and bleeding events following PCI for ACS. We constructed Cox proportional hazards models to compare MACE and bleeding in those with versus without HF, adjusting for sociodemographics, comorbidities, and medications. We also determined predictors of MACE and bleeding events in both groups. 370 (32%) individuals did and 775 (68%) did not have HF prior to PCI. Mean age was 61.7 ± 12.2 years, 31% were female, and 24% were African American. After a median follow-up of 0.78 years, individuals with HF had higher rates of MACE compared to those without HF (48 vs. 24 events per 100 person years) which remained significant after multivariable adjustment (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.00 to 1.72). Similarly, bleeding was higher in those with versus without HF (22 vs. 11 events per 100 person years), although this was no longer statistically significant after multivariable adjustment (HR 1.29, 95% CI 0.86 to 1.93). Diabetes and peripheral vascular disease were predictors of MACE, and end-stage renal disease was a predictor of bleeding among participants with HF. MACE risk is higher in individuals with versus without HF following PCI for ACS. However, the risk of bleeding, especially among those with end-stage renal disease , must be considered when determining post-PCI anticoagulant strategies.
在接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者中，心力衰竭（HF）患者的主要不良心脏事件（MACE）和出血风险尚未得到明确界定。我们在 Pharmacogenomic Resource 中随访了 1145 名患者，以改善药物有效性基因指导抗血小板治疗队列的 MACE 和 ACS 患者 PCI 后的出血事件。我们构建了 Cox 比例风险模型，以比较有和无 HF 的患者的 MACE 和出血情况，调整了社会人口统计学、合并症和药物因素。我们还确定了两组中 MACE 和出血事件的预测因素。在 PCI 之前，370 名（32%）患者有 HF，775 名（68%）患者没有 HF。平均年龄为 61.7 ± 12.2 岁，31%为女性，24%为非裔美国人。在中位随访 0.78 年后，有 HF 的患者与无 HF 的患者相比，MACE 发生率更高（每 100 人年 48 例 vs. 24 例），在多变量调整后仍然显著（风险比[HR] 1.31，95%置信区间[CI] 1.00 至 1.72）。同样，有 HF 的患者出血率高于无 HF 的患者（每 100 人年 22 例 vs. 11 例），但在多变量调整后这不再具有统计学意义（HR 1.29，95%CI 0.86 至 1.93）。糖尿病和外周血管疾病是 MACE 的预测因素，而终末期肾病是 HF 患者出血的预测因素。ACS 患者接受 PCI 后，有 HF 的患者发生 MACE 的风险更高。然而，在确定 PCI 后的抗凝策略时，必须考虑出血风险，尤其是终末期肾病患者。
