Ng Andrew Kei-Yan, Ng Pauline Yeung, Ip April, Ling Ian Wood-Hay, Lam Lap-Tin, Siu Chung-Wah
Cardiac Medical Unit, Grantham Hospital, Hong Kong SAR, China.
Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong SAR, China.
JACC Asia. 2022 Apr 26;2(3):341-350. doi: 10.1016/j.jacasi.2021.12.009. eCollection 2022 Jun.
The patterns of late major bleeding (MB) after percutaneous coronary intervention (PCI) remain unknown in Chinese patients.
This study sought to determine the incidence, prediction, and long-term outcomes of late MB in Chinese patients.
This was a retrospective cohort study from 14 hospitals in Hong Kong. Participants were patients undergoing first-time PCI without MB within 30 days or death within 1 year. Patients were stratified by the presence of late MB, defined as MB between 30 and 365 days. The primary endpoint was all-cause mortality. The secondary endpoints were major adverse cardiac events (MACE).
A total of 32,057 patients were analyzed. After adjustment for baseline characteristics, periprocedural characteristics, and medications on discharge, the risks of all-cause mortality at 5 years were significantly higher with late MB (HR: 2.15; 95% CI: 1.92-2.41; 0.001). Late MB was also associated with a higher risk of MACE (HR: 1.57; 95% CI: 1.03-1.50; 0.001), myocardial infarction (HR: 1.25; 95% CI: 1.04-1.52; 0.02), and stroke (HR: 1.38; 95% CI: 1.09-1.73; 0.006). The CARDIAC (anti-Coagulation therapy, Age, Renal insufficiency, Drop In hemoglobin, baseline Anemia in Chinese patients) score had a good discriminating power for prediction of MB within 365 days (area under the receiver-operating characteristic curve: 0.76).
Late MB was independently associated with a higher risk of mortality, MACE, myocardial infarction, and stroke in patients undergoing PCI. The CARDIAC score is a simple model that can predict MB after PCI. Prevention of MB represents an important strategy to optimize cardiovascular outcomes for patients undergoing PCI.
中国患者经皮冠状动脉介入治疗（PCI）后晚期严重出血（MB）的模式尚不清楚。
本研究旨在确定中国患者晚期MB的发生率、预测因素及长期预后。
这是一项来自香港14家医院的回顾性队列研究。参与者为首次接受PCI且在30天内无MB或1年内无死亡的患者。患者按晚期MB的存在情况分层，晚期MB定义为30至365天内发生的MB。主要终点为全因死亡率。次要终点为主要不良心脏事件（MACE）。
共分析了32057例患者。在对基线特征、围手术期特征和出院时用药进行调整后，晚期MB患者5年全因死亡风险显著更高（HR：2.15；95%CI：1.92 - 2.41；P<0.001）。晚期MB还与更高的MACE风险（HR：1.57；95%CI：1.03 - 1.50；P<0.001）、心肌梗死（HR：1.25；95%CI：1.04 - 1.52；P = 0.02）和卒中（HR：1.38；95%CI：1.09 - 1.73；P = 0.006）相关。CARDIAC（抗凝治疗、年龄、肾功能不全、血红蛋白下降、中国患者基线贫血）评分对预测365天内的MB具有良好的鉴别能力（受试者操作特征曲线下面积：0.76）。
晚期MB与PCI患者更高的死亡、MACE、心肌梗死和卒中风险独立相关。CARDIAC评分是一个可预测PCI后MB的简单模型。预防MB是优化PCI患者心血管结局的重要策略。
