PCI围术期比伐芦定抗凝的急性冠脉综合征患者出血事件发生情况及影响因素分析  

Analysis of bleeding events and their influence factors in patients with acute coronary syndrome treated with bivalirudin during perioperative period of PCI

作　　者：姚卫杰 胡越成[4] 丛洪良[4] 张敬霞[4] 王乐[4] YAO Weijie;HU Yuecheng;CONG Hongliang;ZHANG Jingxia;WANG Le(Graduate School of Tianjin Medical University, Tianjin 300070, China)

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津医科大学胸科临床学院 [3]天津医科大学代谢病医院 [4]天津市胸科医院

出　　处：《山东医药》2019年第21期23-27,共5页Shandong Medical Journal

基　　金：天津市胸科医院科研项目基金(2018XKZ07)

摘　　要：目的探讨PCI围术期静脉注射比伐芦定抗凝的急性冠脉综合征患者1年内出血事件[符合出血学术研究会(BARC)定义的2~5型出血事件标准]发生情况及其影响因素。方法选取PCI围术期静脉注射比伐芦定抗凝的急性冠脉综合征患者706例,收集年龄、性别、既往病史等临床基线资料和药物应用、手术治疗情况等指标。随访1年,统计出血事件发生例数。根据是否出现出血事件将患者分为出血组与无出血组,比较两组上述收集的资料。应用COX回归分析出血事件的影响因素。结果 PCI围术期静脉注射比伐芦定抗凝的急性冠脉综合征患者1年内出血事件发生率为5. 4%。与无出血组比较,出血组高龄、阿司匹林应用、氯吡格雷应用、替格瑞洛应用、CRUSADE评分> 30分、贫血、急诊PCI、有卒中史、e GFR <60 m L/min患者所占比例高(P均<0. 05)。桡动脉入路、ACEI/ARB应用患者比例低(P均<0. 05)。COX回归分析结果显示,急诊PCI(OR:11. 090,95%CI:4. 191~29. 346,P <0. 01)、高龄(OR:1. 065,95%CI:1. 016~1. 116,P=0. 008)、贫血(OR:2. 502,95%CI:1. 224~5. 111,P=0. 012)是PCI围术期静脉注射比伐芦定抗凝的急性冠脉综合征患者1年内出血事件的独立危险因素。桡动脉入路(OR:0. 262,95%CI:0. 111~0. 621,P=0. 002)、术后应用ACEI/ARB类药物(OR:0. 491,95%CI:0. 248~0. 974,P=0. 042)为PCI围术期静脉注射比伐芦定抗凝的急性冠脉综合征患者1年内出血事件的保护因素。结论PCI围术期静脉注射比伐芦定抗凝的急性冠脉综合征患者1年内出血事件发生率高,其独立危险因素为急诊PCI、高龄、贫血,独立保护因素为桡动脉入路、应用ACEI/ARB类药物。Objective To investigate the occurrence and influencing factors of bleeding events [type 2-5 defined by the bleeding academic research consortium( BARC) ]in patients with acute coronary syndrome( ACS) who received intravenous bivalirudin injection during perioperative period of percutaneous coronary intervention( PCI). Methods Totally 706 patients with ACS who received intravenous bivalirudin injection during perioperative period of PCI were retrospectively enrolled. The clinical baseline data such as age,sex,past medical history,medication and surgical treatment were collected.They were followed up for 1 year,and the number of bleeding incidents was counted. According to the occurrence of bleeding events,patients were divided into the bleeding group and non-bleeding group,and the data collected above were compared between the two groups. COX regression equation was used to analyze the independent influence factors of bleeding events. Results One-year follow-up showed that the incidence of bleeding events in patients with ACS who received bivalirudin during PCI was 5. 4%. Compared with the non-bleeding group,the proportion of the elderly,aspirin,clopidogrel,ticagrelor,CRUSADE score > 30 points,anemia,primary PCI,stroke history,and e GFR < 60 m L/min in the bleeding group was higher( all P < 0. 05). The proportion of patients using radial artery approach and ACEI/ARB was lower in the bleeding group( P < 0. 05). COX regression analysis showed that the primary PCI( OR: 11. 090,95% CI: 4. 191-29. 346,P < 0. 01),the elderly( OR: 1. 065,95% CI: 1. 016-1. 116,P = 0. 008),anemia( OR: 2. 502,95% CI: 1. 224-5. 111,P = 0. 012) were independent risk factors for 1-year bleeding events in patients with ACS who received intravenous bivalirudin injection during perioperative period of PCI. Trans-radial approach( OR: 0. 262,95% CI: 0. 111-0. 621,P = 0. 002)and ACEI/ARB drugs( OR: 0. 491,95% CI: 0. 248-0. 974,P = 0. 042) were protective factors for 1-year bleeding events in patients with ACS who received intravenous bivalirudin in

关 键 词：比伐芦定 冠状动脉疾病 急性冠脉综合征 出血事件 经皮冠状动脉介入治疗 

分 类 号：R541[医药卫生—心血管疾病]