CAJ | 학술논문

目的分析急性ST段抬高型心肌梗死(STEMI)接受急症冠状动脉介入治疗(PCI)后发生严重出血患者的临床预后.方法回顾性分析2004年1月至2008年1月间412例急性STEMI接受急症PCI患者资料.比较严重出血患者(严重出血组)和其他患者(对照组)住院期间和术后1年主要心脏不良事件(MACE,包括死亡、再次心肌梗死和靶血管再次血运重建率)的发生率.结果与对照组比较,严重出血组年龄较大[(70±9)岁比(65±13)岁,P=0.04] ,女性多见(51.9%比23.1%,P<0.01)、血小板Ⅱb/Ⅲa受体拮抗剂(88.9%比69.4%,P=0.03)及主动脉内球囊反搏泵(7.4%比1.3%,P=0.02)使用率增加;住院期间和1年临床MACE发生牢增高(分别为18.5%比5.7%,P=0.008;37.0%比14.3%,P=0.002).多因素分析表明,年龄>70岁、女性、应用血小板Ⅱb/Ⅲa受体拮抗剂是发生严重出血的独立预测因素;严重出血是术后1年发生MACE的独立预测因素(OR:2.79,95%CI:2.21～5.90,P<0.01).结论急性STEMI患者急症PCI并发严重出血患者术后1年MACE发生率显著增高,女性、高龄和应用血小板Ⅱb/Ⅲa受体拮抗剂是发生严重出血的独立预测因素.
목적 분석급성ST단태고형심기경사(STEMI)접수급증관상동맥개입치료(PCI)후발생엄중출혈환자적림상예후.방법 회고성분석2004년1월지2008년1월간412례급성STEMI접수급증PCI환자자료.비교엄중출혈환자(엄중출혈조)화기타환자(대조조)주원기간화술후1년주요심장불량사건(MACE,포괄사망、재차심기경사화파혈관재차혈운중건솔)적발생솔.결과 여대조조비교,엄중출혈조년령교대[(70±9)세비(65±13)세,P=0.04] ,녀성다견(51.9%비23.1%,P<0.01)、혈소판Ⅱb/Ⅲa수체길항제(88.9%비69.4%,P=0.03)급주동맥내구낭반박빙(7.4%비1.3%,P=0.02)사용솔증가;주원기간화1년림상MACE발생뢰증고(분별위18.5%비5.7%,P=0.008;37.0%비14.3%,P=0.002).다인소분석표명,년령>70세、녀성、응용혈소판Ⅱb/Ⅲa수체길항제시발생엄중출혈적독립예측인소;엄중출혈시술후1년발생MACE적독립예측인소(OR:2.79,95%CI:2.21～5.90,P<0.01).결론 급성STEMI환자급증PCI병발엄중출혈환자술후1년MACE발생솔현저증고,녀성、고령화응용혈소판Ⅱb/Ⅲa수체길항제시발생엄중출혈적독립예측인소.
Objective To evaluate the clinical outcomes of patients complicated with major bleeding after primary coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods During the period of January 2004-January 2008, primary PC1 was performed in 412 consecutive patients with acute STEMI at Shanghai Ruijin Hospital. The clinical data were retrospectively analyzed. Major adverse cardiac events (MACE), including death, reoccurrence of myocardial infarction and target vessel revascularization, in patients with major bleeding were compared with that in patients without major bleeding. Results Compared to patients without bleeding, the patients with bleeding were older (70.0 ± 8.9 years vs 64.9 ± 12.7 years, P = 0.04), mainly the females (51.9% vs 23.1%, P = 0.001) and treated more often with glycoprotein (GP) Ⅱb/Ⅲa receptor inhibitor (88.9% vs 69.4%, P = 0.03) or intra-aortic balloon pump (7.4% vs 1.3%, P = 0.02). In-hospital and one-year MACE rate in the patients with bleeding was 18.5% and 37.0% respectively, which were significantly higher than that in the patients without bleeding (5.7% and 14.3%, with P = 0.008 and P = 0.002, respectively). Multivariate analysis indicated that patient aged over 70 years, feminine gender and use of GP Ⅱb/Ⅲa receptor inhibitor were independent predictors for the occurrence of major bleeding. The occurrence of major bleeding after primary PCI was significantly correlated with MACE occurred within one year after the procedure (OR 2.79, 95% CI: 2.21-5.90, P < 0.001). Conclusion In patients with acute STEMI, the occurrence of major bleeding after primary PCI is closely linked to the increased MACE rate within one year after the treatment. Feminine gender, aged patient and use of GP Ⅱb/Ⅲa receptor inhibitor are independent predictors to increase the danger of major bleeding.