{"title":"住院期间收缩压的变化和经皮冠状动脉介入治疗后出血事件。","authors":"Yasuhiro Otsuka, Masanobu Ishii, So Ikebe, Taishi Nakamura, Kenichi Tsujita, Tetsuya Matoba, Takahide Kohro, Yusuke Oba, Tomoyuki Kabutoya, Kazuomi Kario, Yasushi Imai, Arihiro Kiyosue, Yoshiko Mizuno, Kotaro Nochioka, Masaharu Nakayama, Takamasa Iwai, Yoshihiro Miyamoto, Hisahiko Sato, Naoyuki Akashi, Hideo Fujita, Ryozo Nagai","doi":"10.1136/openhrt-2024-002987","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Hypertension is a risk factor for bleeding events and is included in the HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/Alcohol concomitantly)score. However, the effects of blood pressure (BP) and changes in BP on bleeding events in patients undergoing percutaneous coronary intervention (PCI) remain poorly understood. This study is aimed to investigate the relationship between systolic BP (SBP) changes during hospitalisation and bleeding events in patients undergoing PCI.</p><p><strong>Methods: </strong>From the Clinical Deep Data Accumulation System database, a multicentre database encompassing seven tertiary medical hospitals in Japan that includes data for patient characteristics, medications, laboratory tests, physiological tests, cardiac catheterisation and PCI treatment, data for 6351 patients undergoing PCI between April 2013 and March 2019 were obtained. The study population was categorised into three groups based on the changes in SBP during hospitalisation: (1) elevated BP (≥20 mm Hg), (2) no change (≥-20 to <20 mm Hg) and (3) decreased BP (<-20 mm Hg) groups. The primary outcome was a 3-year major bleeding event defined as moderate or severe bleeding according to the Global Use of Streptokinase and t-PA for Occluded Coronary Arteries bleeding criteria.</p><p><strong>Results: </strong>The elevated BP group exhibited significantly lower SBP at admission and higher SBP at discharge (p<0.001). Multivariable Cox hazard regression models showed that elevated BP was associated with a high risk of bleeding events (HR: 1.885; 95% CI, 1.294 to 2.748). The multivariable logistic regression model identified female sex, chronic coronary syndrome, peripheral artery disease and chronic kidney disease as independent factors associated with elevated BP.</p><p><strong>Conclusions: </strong>These findings suggest that BP management is essential to prevent bleeding events after PCI.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"11 2","pages":""},"PeriodicalIF":2.8000,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667424/pdf/","citationCount":"0","resultStr":"{\"title\":\"Changes in systolic blood pressure during hospitalisation and bleeding events after percutaneous coronary intervention.\",\"authors\":\"Yasuhiro Otsuka, Masanobu Ishii, So Ikebe, Taishi Nakamura, Kenichi Tsujita, Tetsuya Matoba, Takahide Kohro, Yusuke Oba, Tomoyuki Kabutoya, Kazuomi Kario, Yasushi Imai, Arihiro Kiyosue, Yoshiko Mizuno, Kotaro Nochioka, Masaharu Nakayama, Takamasa Iwai, Yoshihiro Miyamoto, Hisahiko Sato, Naoyuki Akashi, Hideo Fujita, Ryozo Nagai\",\"doi\":\"10.1136/openhrt-2024-002987\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Hypertension is a risk factor for bleeding events and is included in the HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/Alcohol concomitantly)score. However, the effects of blood pressure (BP) and changes in BP on bleeding events in patients undergoing percutaneous coronary intervention (PCI) remain poorly understood. This study is aimed to investigate the relationship between systolic BP (SBP) changes during hospitalisation and bleeding events in patients undergoing PCI.</p><p><strong>Methods: </strong>From the Clinical Deep Data Accumulation System database, a multicentre database encompassing seven tertiary medical hospitals in Japan that includes data for patient characteristics, medications, laboratory tests, physiological tests, cardiac catheterisation and PCI treatment, data for 6351 patients undergoing PCI between April 2013 and March 2019 were obtained. The study population was categorised into three groups based on the changes in SBP during hospitalisation: (1) elevated BP (≥20 mm Hg), (2) no change (≥-20 to <20 mm Hg) and (3) decreased BP (<-20 mm Hg) groups. The primary outcome was a 3-year major bleeding event defined as moderate or severe bleeding according to the Global Use of Streptokinase and t-PA for Occluded Coronary Arteries bleeding criteria.</p><p><strong>Results: </strong>The elevated BP group exhibited significantly lower SBP at admission and higher SBP at discharge (p<0.001). Multivariable Cox hazard regression models showed that elevated BP was associated with a high risk of bleeding events (HR: 1.885; 95% CI, 1.294 to 2.748). The multivariable logistic regression model identified female sex, chronic coronary syndrome, peripheral artery disease and chronic kidney disease as independent factors associated with elevated BP.</p><p><strong>Conclusions: </strong>These findings suggest that BP management is essential to prevent bleeding events after PCI.</p>\",\"PeriodicalId\":19505,\"journal\":{\"name\":\"Open Heart\",\"volume\":\"11 2\",\"pages\":\"\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2024-12-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667424/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Open Heart\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1136/openhrt-2024-002987\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Open Heart","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1136/openhrt-2024-002987","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景：高血压是出血事件的危险因素，包括在ha - bled（高血压、肾/肝功能异常、中风、出血史或易感性、不稳定INR、老年人、药物/酒精合并）评分中。然而，血压（BP）和血压变化对经皮冠状动脉介入治疗（PCI）患者出血事件的影响仍然知之甚少。本研究旨在探讨住院期间收缩压（SBP）变化与PCI患者出血事件之间的关系。方法：从临床深度数据积累系统数据库（一个包括日本七家三级医院的多中心数据库，包括患者特征、药物、实验室检查、生理检查、心导管和PCI治疗的数据）中获取2013年4月至2019年3月期间6351名接受PCI治疗的患者的数据。根据住院期间收缩压的变化，将研究人群分为三组：(1)血压升高（≥20 mm Hg），(2)无变化（≥-20 mm Hg）。结果：血压升高组入院时收缩压明显降低，出院时收缩压明显升高(结论：这些发现表明血压管理对于预防PCI术后出血事件至关重要。
Changes in systolic blood pressure during hospitalisation and bleeding events after percutaneous coronary intervention.
Background: Hypertension is a risk factor for bleeding events and is included in the HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/Alcohol concomitantly)score. However, the effects of blood pressure (BP) and changes in BP on bleeding events in patients undergoing percutaneous coronary intervention (PCI) remain poorly understood. This study is aimed to investigate the relationship between systolic BP (SBP) changes during hospitalisation and bleeding events in patients undergoing PCI.
Methods: From the Clinical Deep Data Accumulation System database, a multicentre database encompassing seven tertiary medical hospitals in Japan that includes data for patient characteristics, medications, laboratory tests, physiological tests, cardiac catheterisation and PCI treatment, data for 6351 patients undergoing PCI between April 2013 and March 2019 were obtained. The study population was categorised into three groups based on the changes in SBP during hospitalisation: (1) elevated BP (≥20 mm Hg), (2) no change (≥-20 to <20 mm Hg) and (3) decreased BP (<-20 mm Hg) groups. The primary outcome was a 3-year major bleeding event defined as moderate or severe bleeding according to the Global Use of Streptokinase and t-PA for Occluded Coronary Arteries bleeding criteria.
Results: The elevated BP group exhibited significantly lower SBP at admission and higher SBP at discharge (p<0.001). Multivariable Cox hazard regression models showed that elevated BP was associated with a high risk of bleeding events (HR: 1.885; 95% CI, 1.294 to 2.748). The multivariable logistic regression model identified female sex, chronic coronary syndrome, peripheral artery disease and chronic kidney disease as independent factors associated with elevated BP.
Conclusions: These findings suggest that BP management is essential to prevent bleeding events after PCI.
期刊介绍：
Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.
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