Cortés Pedro, Zeng Jennifer J, Karime Christian, Lewis Michele D, Gharacholou S Michael, Antwi Samuel O, Pang Maoyin
Division of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, Maryland, USA.
Gastrointest Endosc. 2024 Jan;99(1):10-20.e6. doi: 10.1016/j.gie.2023.08.002. Epub 2023 Aug 12.
The management of dual anti-platelet therapy after percutaneous coronary intervention (PCI) and GI bleeding (GIB) remains a clinical dilemma. We sought to identify predictors of GIB and recurrent bleeding and to determine whether recurrent bleeding increases the risk of major adverse cardiovascular events (MACEs).
In this single-center retrospective study, patients undergoing PCI were identified. The primary and secondary endpoints were GIB at 180 days and recurrent bleeding or MACE at 365 days. Logistic regression was used to identify predictors of GIB and recurrent bleeding. Cox proportional hazards modeling was used to determine whether recurrent bleeding can predict a MACE.
Five hundred thirty-six patients were included. On multivariable analysis, PCI for acute coronary syndrome was associated with a 95% increased odds of GIB (P < .001). The P2Y inhibitor was continued in >90% of patients, which trended toward significance for recurrent bleeding (P < .10). The HAS-BLED score (Hypertension, Abnormal renal and liver function, Stroke, Bleeding tendency or predisposition, Labile INRs, Elderly, Drugs), including a labile international normalized ratio and prior major bleeding, was strongly associated with recurrent bleeding (P ≤ .009). Recurrent bleeding was associated with a 115% increased risk of MACEs (P = .02). We derived a novel risk score, named the SIGE score ([S]TEMI at PCI, having a labile [I]NR at PCI, index [G]IB within 180 days of PCI, and previous precatheterization [E]ndoscopy within 6 months), to predict recurrent bleeding at 365 days with a high predictive accuracy (area under the curve, .773; 95% confidence interval, .702-.845).
The SIGE score may help to predict recurrent bleeding, which was shown to be associated with an increased risk of MACEs. Further external validation is needed.
经皮冠状动脉介入治疗（PCI）后双联抗血小板治疗与胃肠道出血（GIB）的管理仍是一个临床难题。我们试图确定GIB和复发性出血的预测因素，并确定复发性出血是否会增加主要不良心血管事件（MACE）的风险。
在这项单中心回顾性研究中，确定了接受PCI的患者。主要和次要终点分别为180天时的GIB以及365天时的复发性出血或MACE。采用逻辑回归确定GIB和复发性出血的预测因素。采用Cox比例风险模型确定复发性出血是否可预测MACE。
纳入536例患者。多变量分析显示，急性冠状动脉综合征的PCI与GIB几率增加95%相关（P <.001）。超过90%的患者继续使用P2Y抑制剂，这对复发性出血有显著趋势（P <.10）。HAS - BLED评分（高血压、肝肾功能异常、中风、出血倾向或易感性、国际标准化比值不稳定、老年人、药物），包括国际标准化比值不稳定和既往大出血，与复发性出血密切相关（P≤.009）。复发性出血与MACE风险增加115%相关（P =.02）。我们得出了一个新的风险评分，名为SIGE评分（PCI时的[STEMI，PCI时国际标准化比值不稳定，PCI后180天内的索引[G]IB，以及导管插入术前6个月内的既往[E]内镜检查），以预测365天时的复发性出血，预测准确性较高（曲线下面积，.773；95%置信区间，.702 -.845）。
SIGE评分可能有助于预测复发性出血，而复发性出血与MACE风险增加相关。需要进一步的外部验证。
