Independent predictors of bleeding events within 30 days in patients with acute coronary syndrome treated with bivalirudin during PCI
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摘要: 目的:分析经皮冠状动脉介入(PCI)围术期应用比伐芦定的急性冠状动脉综合征患者30 d内出血事件发生情况及其独立预测因素。方法:连续入选天津市胸科医院2016-05-2017-10期间PCI术中应用比伐芦定的冠心病患者706例,应用普通肝素患者710例。随访30 d,统计出血事件。根据出血与否将比伐芦定组患者分为出血组与无出血组,比较两组患者临床资料。应用Logistic回归方程分析30 d内出血事件的独立预测因素。结果:30 d内出血事件发生率比伐芦定组与普通肝素组相似(2.3%∶3.4%,P>0.05),但比伐芦定组患者CRUSADE评分,合并糖尿病、高血压、贫血、中重度肾功能不全、心肌梗死病史、PCI病史、消化道出血病史比例明显高于普通肝素组(P<0.05)。Logistic回归分析显示,女性(OR:8.954,95%CI:1.885~42.528,P=0.006)、贫血(OR:4.746,95%CI:1.407~16.000,P=0.012)是比伐芦定组患者30 d内出血事件的独立危险因素。结论:PCI围术期应用比伐芦定抗凝治疗30 d内出血事件发生率较低,特别是在具有较高出血风险患者中。女性、贫血是PCI围术期应用比伐芦定患者30 d内出血事件的独立危险因素。Abstract: Objective:To analyze the incidence of bleeding events and independent predictors in patients with acute coronary syndrome(ACS) treated with bivalirudin during perioperative PCI in the real world.Method:The 706 patients treated with bivalirudin and 710 patients treated with heparin during PCI were enrolled continuously in Tianjin Chest Hospital from May 2016 to October 2017.The bleeding event was counted within 30 days follow-up.Patients treated with bivalirudin were divided into bleeding group and non-bleeding group according to bleeding or not.Logistic regression equations were used to analyze independent predictors of bleeding events within 30 days.Result:In this study,the incidence of bleeding events within 30 days was similar in bivalirudin group and unfractionated heparin group(2.3% vs 3.4%,P＞0.05),but the CRUSADE score of patients treated with bivalirudin,combining diabetes mellitus,hypertension,anemia,moderate to severe renal insufficiency,history of myocardial infarction,history of PCI and history of gastrointestinal bleeding were significantly higher than those of patients with unfractionated heparin(P＜0.05).Logistic regression analysis showed that women(OR:8.954,95%CI:1.885-42.528,P=0.006),anemia(OR:4.746,95%CI:1.407-16.000,P=0.012) were independent risk factors for bleeding events within 30 days in patients with bivalirudin.Conclusion:The incidence of bleeding events within 30 days after PCI treated with bivalirudin was lower,especially in those patients with higher risk of bleeding.Female and anemia were independent risk factors for bleeding events within 30 days in patients treated with bivalirudin during PCI.
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Key words:
- bivalirudin /
- bleeding /
- percutaneous coronary intervention
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