评估近期消化道出血后经皮冠状动脉介入治疗的安全性

Saima Karim, Sweetheart T. Ador-Dionisio, M. Karim, Mohammad Karim, Sadaf S Khan, A. Atreja, S. Ellis
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引用次数: 2

摘要

背景:尽管PCI术后出血已被确定为长期死亡的危险因素,但关于近期胃肠道出血患者行冠状动脉介入治疗(PCI)风险的文献很少。方法:回顾性比较克利夫兰诊所PCI数据库中同一住院期间PCI术前30天内发生急性GIB的患者(n = 79)与近期未发生GIB的PCI患者(n = 10979)的死亡率和血管重建术需求。对分类变量使用卡方检验,对连续变量使用Wilcoxon秩和检验,比较基线特征、实验室值、程序、发病率和死亡率。死亡率数据采用社会安全死亡指数(Social Security Death Index)获取,并采用Kaplan-Meier法进行论证。结果:GIB组消化性溃疡、GIB、胃肠道或肝脏疾病(P < 0.0001)、短暂性脑缺血意外(P = 0.017)、外周血管疾病(P = 0.0002)、颈动脉明显闭塞(P = 0.023)、心肌梗死(P < 0.0001)病史更为普遍。47%的患者有上GIB, 20%的患者需要内镜干预。该组贫血(P < 0.0001)、心力衰竭(P = 0.0001)、心源性休克(10%比1.4%,P < 0.001)、心脏骤停(7.6%比1%,P < 0.001)较多。GIB组住院死亡率(P < 0.0001)、长期死亡率(P < 0.001)较低,再出血发生率为7.6%。结论:总体而言,PCI前有GIB的患者与PCI前无GIB的患者相比,住院死亡率和长期死亡率更高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Assessment of safety of performing percutaneous coronary intervention after a recent episode of gastrointestinal bleeding
Background: Little literature exists on the risk of performing coronary intervention (PCI) on patients who have had recent gastrointestinal bleeding (GIB), although bleeding after PCI has been identified as a risk factor for long-term mortality. Methods: Patients within the Cleveland Clinic PCI database who had acute GIB within 30 days preceding PCI during the same hospitalization (n = 79) were retrospectively compared to those who had PCI without recent GIB (n = 10 979) for mortality and need for revascularization. Baseline characteristics, laboratory values, procedures, morbidities, and mortality were compared using chi-square test for categorical variables and using Wilcoxon rank sum test for continuous variables. Mortality data was obtained using Social Security Death Index and demonstrated using Kaplan–Meier method. Results: The GIB group had more prevalent history of peptic ulcer disease, GIB, gastrointestinal or liver disease (P < 0.0001), transient ischemic accident (P = 0.017), peripheral vascular disease (P = 0.0002), significant carotid artery occlusion (P = 0.023), and myocardial infarction (P < 0.0001). 47% of patients had upper GIB with 20% needing endoscopic intervention. This group had more anemia (P < 0.0001), heart failure (P = 0.0001), cardiogenic shock (10% versus 1.4%, P < 0.001), cardiac arrest (7.6% versus 1%, P < 0.001). GIB group had worse in-hospital mortality (P < 0.0001), long-term mortality (P < 0.001), and a 7.6% re-bleeding incidence. Conclusions: Overall, the patients who had GIB preceding PCI had higher in-hospital mortality and long-term mortality compared with those without GIB before PCI.
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