Sun Yihong, Feng Lin, Li Xian, Wang Zhe, Gao Runlin, Wu Yangfeng
China-Japan Friendship Hospital, Beijing, China.
Peking University Clinical Research Institute, Beijing, China.
Front Cardiovasc Med. 2022 Oct 31;9:878270. doi: 10.3389/fcvm.2022.878270. eCollection 2022.
Major bleeding is associated with poor hospital prognosis in patients with acute coronary syndrome (ACS). Despite its clinical importance, there are limited studies on the incidence and risk factors for major bleeding in ACS patients with dual anti-platelet therapy (DAPT) without access to revascularization.
We analyzed data from 19,186 patients on DAPT after ACS with no access to revascularization from Clinical Pathway for Acute Coronary Syndrome in China Phase 3 (CPACS-3) cohort, which was conducted from 2011 to 2014. Major bleeding included intracranial hemorrhage, clinically significant bleeding, or bleeding requiring blood transfusion. Factors associated with in-hospital major bleeding were assessed using Poisson regressions with generalized estimating equations to account for the clustering effect.
A total of 75 (0.39%) patients experienced major bleeding during hospitalization. Among subtypes of ACS, 0.65% of patients with STEMI, 0.33% with NSTEMI, and 0.13% with unstable angina had in-hospital major bleeding ( < 0.001). The patients who experienced major bleeding had a longer length of stay (median 12 vs. 9 days, = 0.011) and a higher all-cause in-hospital death rate (22.7 vs. 3.7%, < 0.001). Multivariable analysis showed advancing age (RR = 1.52 for every 10 years increase, 95% CI: 1.13, 2.05), impaired renal function (RR = 1.79, 95% CI: 1.10, 2.92), use of fibrinolytic drugs (RR = 2.93, 95% CI: 1.55, 5.56), and severe diseases other than cardiovascular and renal diseases (RR = 5.56, 95% CI: 1.10, 28.07) were associated with increased risk of major bleeding, whereas using renin-angiotensin system inhibitors (RR = 0.54, 95% CI: 0.36, 0.81) was associated with decreased risk of major bleeding. These independent factors together showed good predictive accuracy with an AUC of 0.788 (95% CI: 0.734, 0.841).
Among ACS patients on DAPT, advancing age, impaired renal function, thrombolytic treatment, and severe comorbidities were independently associated with a higher risk of in-hospital major bleeding.
在急性冠状动脉综合征（ACS）患者中，大出血与不良的医院预后相关。尽管其具有临床重要性，但对于接受双联抗血小板治疗（DAPT）且无法进行血运重建的ACS患者，关于大出血的发生率和危险因素的研究有限。
我们分析了中国急性冠状动脉综合征临床路径第3阶段（CPACS - 3）队列中19186例ACS后接受DAPT且无法进行血运重建的患者的数据，该队列研究于2011年至2014年进行。大出血包括颅内出血、具有临床意义的出血或需要输血的出血。使用泊松回归和广义估计方程评估与院内大出血相关的因素，以考虑聚类效应。
共有75例（0.39%）患者在住院期间发生大出血。在ACS的亚型中，ST段抬高型心肌梗死（STEMI）患者中有0.65%、非ST段抬高型心肌梗死（NSTEMI）患者中有0.33%、不稳定型心绞痛患者中有0.13%发生院内大出血（P < 0.001）。发生大出血的患者住院时间更长（中位数12天对9天，P = 0.011），院内全因死亡率更高（22.7%对3.7%，P < 0.001）。多变量分析显示，年龄增长（每增加10岁风险比[RR] = 1.52，95%置信区间[CI]：1.13，2.05）、肾功能受损（RR = 1.79，95% CI：1.10，2.92）、使用纤溶药物（RR = 2.93，95% CI：1.55，5.56）以及除心血管和肾脏疾病外的严重疾病（RR = 5.56，95% CI：1.10，28.07）与大出血风险增加相关，而使用肾素 - 血管紧张素系统抑制剂（RR = 0.54，95% CI：0.36，0.81）与大出血风险降低相关。这些独立因素共同显示出良好的预测准确性，曲线下面积（AUC）为0.788（95% CI：0.734，0.841）。
在接受DAPT的ACS患者中，年龄增长、肾功能受损、溶栓治疗和严重合并症与院内大出血风险较高独立相关。
