Kobayashi Nobuaki, Shibata Yusaku, Kurihara Osamu, Todoroki Takahiro, Tsutsumi Masayuki, Shirakabe Akihiro, Shigihara Shota, Sawatani Tomofumi, Kiuchi Kazutaka, Takano Masamichi, Asai Kuniya
Department of Cardiology, Nippon Medical School Chiba Hokusoh Hospital Inzai Japan.
Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital Inzai Japan.
Circ Rep. 2024 Feb 17;6(3):64-73. doi: 10.1253/circrep.CR-24-0003. eCollection 2024 Mar 8.
Although the clinical factors that predict major bleeding in Western patients with acute coronary syndrome (ACS) are becoming elucidated, they have not been fully investigated, especially coronary lesion characteristics, in a Japanese population. ACS patients (n=1,840) were divided into a "bleeding group" and a "no-bleeding group," according to whether they had major bleeding during the 2-year follow-up period, to investigate the prognostic effect of bleeding and the predictive factors of bleeding. Among them, patients who underwent primary percutaneous coronary intervention with optical coherence tomography (OCT) guidance (n=958) were examined to identify the effect of coronary lesion characteristics on bleeding. Of the 1,840 enrolled patients, 124 (6.7%) experienced major bleeding during the 2-year follow-up period. Incidence of cardiovascular death during the 2-year follow-up period was significantly higher among patients with major bleeding (26.4% vs. 8.5%, P=0.001). OCT examination showed that disrupted fibrous cap (DFC: 68% vs. 48%, P=0.014) and calcified plaque (63% vs. 42%, P=0.011) were more prevalent in the bleeding group. DFC was a predictor of major bleeding in the multivariate Cox proportional hazards analyses (hazard ratio 2.135 [95% confidence interval 1.070-4.263], P<0.001). ACS patients with major bleeding had poorer cardiac outcomes. Advanced atherosclerosis at the culprit lesion influences the higher incidence of major bleeding in ACS patients.
虽然预测西方急性冠状动脉综合征（ACS）患者大出血的临床因素正逐渐明晰，但在日本人群中尚未得到充分研究，尤其是冠状动脉病变特征。根据2年随访期内是否发生大出血，将1840例ACS患者分为“出血组”和“无出血组”，以研究出血的预后影响及出血的预测因素。其中，对接受光学相干断层扫描（OCT）引导下直接经皮冠状动脉介入治疗的患者（n = 958）进行检查，以确定冠状动脉病变特征对出血的影响。在1840例入组患者中，124例（6.7%）在2年随访期内发生大出血。大出血患者2年随访期内心血管死亡发生率显著更高（26.4%对8.5%，P = 0.001）。OCT检查显示，破裂纤维帽（DFC：68%对48%，P = 0.014）和钙化斑块（63%对42%，P = 0.011）在出血组中更常见。在多变量Cox比例风险分析中，DFC是大出血的预测因素（风险比2.135 [95%置信区间1.070 - 4.263]，P < 0.001）。发生大出血的ACS患者心脏预后较差。罪犯病变处的晚期动脉粥样硬化影响ACS患者大出血的较高发生率。
