Arow Ziad, Ovdat Tal, Gabarin Mustafa, Omelchenko Alexander, Shuvy Mony, Or Tsafrir, Assali Abid, Pereg David
Cardiology Department, Meir Medical Center, Kfar Saba 4428164, Israel.
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel.
Diagnostics (Basel). 2022 Jul 22;12(8):1784. doi: 10.3390/diagnostics12081784.
(1) Background: High bleeding risk is associated with adverse outcomes in ACS patients. We aimed to evaluate temporal trends in treatment and outcomes of ACS patients according to bleeding risk. (2) Methods: Included were ACS patients enrolled in ACSIS surveys. Patients were divided into three groups according to enrolment period: early (2002−2004), mid (2006−2010) and recent (2012−2018). Each group was further stratified into three subgroups according to CRUSADE bleeding risk score. The primary endpoints were 30-day MACE and 1-year all-cause mortality. (3) Results: Included were 13,058 ACS patients. High bleeding risk patients were less frequently treated with guideline-based medications and coronary revascularization. They also had higher rates of 30-day MACE and 1-year all-cause mortality regardless of the enrollment period. Among patients enrolled in early period, 30-day MACE rates were 10.8%, 17.5% and 24.3% (p < 0.001) and 1-year all-cause mortality rates were 2%, 7.7% and 23.6% (p < 0.001) in the low, moderate and high bleeding risk groups, respectively. Among patients enrolled in mid period, 30-day MACE rates were 7.7%, 13.4% and 23.5% (p < 0.001) and 1-year all-cause mortality rates were 1.5%, 7.2% and 22.1% (p < 0.001) in low, moderate and high bleeding risk groups, respectively. For patients enrolled in recent period, 30-day MACE rates were 5.7%, 8.6% and 16.2%, (p < 0.001) and 1-year all-cause mortality rates were 2.1%, 6% and 22.4%, (p < 0.001) in low, moderate and high bleeding risk groups, respectively. These differences remained significant following a multivariate analysis. (4) Conclusions: The percentage of patients at high bleeding risk has decreased over the last years. Despite recent improvements in the treatment of ACS patients, high bleeding risk remains a strong predictor of adverse outcomes.
（1）背景：高出血风险与急性冠状动脉综合征（ACS）患者的不良预后相关。我们旨在根据出血风险评估ACS患者治疗及预后的时间趋势。（2）方法：纳入参加急性冠状动脉综合征国际注册研究（ACSIS）调查的ACS患者。根据入组时间将患者分为三组：早期（2002 - 2004年）、中期（2006 - 2010年）和近期（2012 - 2018年）。每组再根据CRUSADE出血风险评分进一步分为三个亚组。主要终点为30天主要不良心血管事件（MACE）和1年全因死亡率。（3）结果：共纳入13058例ACS患者。高出血风险患者接受基于指南的药物治疗和冠状动脉血运重建的频率较低。无论入组时间如何，他们的30天MACE和1年全因死亡率也更高。在早期入组的患者中，低、中、高出血风险组的30天MACE发生率分别为10.8%、17.5%和24.3%（p < 0.001），1年全因死亡率分别为2%、7.7%和23.6%（p < 0.001）。在中期入组的患者中，低、中、高出血风险组的30天MACE发生率分别为7.7%、13.4%和23.5%（p < 0.001），1年全因死亡率分别为1.5%、7.2%和22.1%（p < 0.001）。对于近期入组的患者，低、中、高出血风险组的30天MACE发生率分别为5.7%、8.6%和16.2%（p < 0.001），1年全因死亡率分别为2.1%、6%和22.4%（p < 0.001）。多因素分析后这些差异仍然显著。（4）结论：在过去几年中，高出血风险患者的比例有所下降。尽管近期ACS患者的治疗有所改善，但高出血风险仍然是不良预后的有力预测因素。
