2024 年第 4 期 第 19 卷

急性冠状动脉综合征伴高出血风险患者经皮冠状动脉介入术后抗栓治疗及预后分析

Antithrombotic therapy and prognosis of patients with acute coronary syndrome and high bleeding risk after percutaneous coronary intervention

作者：吴永辉严研聂绍平

英文作者：Wu Yonghui Yan Yan Nie Shaoping

单位：首都医科大学附属北京安贞医院心内冠心病中心，北京100029

英文单位：Intracardiac Coronary Heart Disease Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：急性冠状动脉综合征；高出血风险；经皮冠状动脉介入；预后

英文关键词：Acutecoronarysyndrome;Highbleedingrisk;Percutaneouscoronaryintervention;Prognosis

• 摘要：

• 目的 探讨急性冠状动脉综合征（ACS）伴高出血风险（HBR）患者经皮冠状动脉介入（PCI）治疗术后抗栓治疗及临床预后情况。方法 纳入2022年1月至2023年6月在首都医科大学附属北京安贞医院因ACS住院且行PCI治疗的患者18 382例。根据是否符合HBR学术研究联盟定义，将纳入患者分为HBR组和非HBR组。观察分析HBR对ACS患者PCI术后药物应用及院内结局的影响。结果 18 382例患者中判定为HBR的患者1 471例（HBR组），占8.0%。非HBR组患者16 911例。HBR组和非HBR组患者在入院时除口服抗凝药外其他药物使用比例均无明显差异。在出院用药中，HBR组患者有更高的比例接受氯吡格雷、口服抗凝药治疗［76.89%(1 131/1 471)比63.22%(10 691/16 911)、5.71%(84/1 471)比1.45%(246/16 911)］，而接受替格瑞洛治疗的比例更低［16.38%(241/1 471)比28.45%(4 812/16 911)］(组间比较SMD绝对值均＞0.2)。HBR组患者住院时间长于非HBR组［4(2,5)d比3(2,4)d］(组间比较SMD绝对值＞0.2)。与非HBR组相比，HBR组在死亡、出血和再发心肌梗死事件上的发生比例较高，但SMD绝对值均未超过0.2，差异较小。结论 HBR可显著影响ACS患者PCI的药物应用，并导致不良预后。HBR患者应遵从现行指南管理，积极评估并个体化进行抗栓治疗以改善预后。

• Objective To investigate the antithrombotic therapy and clinical prognosis of acute coronary syndrome (ACS) patients with high bleeding risk (HBR) after percutaneous coronary intervention (PCI). Methods A total of 18 382 ACS patients who underwent PCI in Beijing Anzhen Hospital, Capital Medical University from January 2022 to June 2023 were enrolled.The patients were divided into HBR group and non-HBR group according to whether they met the definition of HBR Academic Research Consortium. The effects of HBR on drug application and in-hospital outcomes in ACS patients after PCI were observed and analyzed. Results Among the 18 382 patients, there were 1 471 cases (accounting for 8.0%) diagnosed as HBR (HBR group) and 16 911 cases in the non-HBR group. There was no significant difference in the proportion of patients using other drugs except oral anticoagulants at admission between the HBR group and the non-HBR group.In the discharge medication, a higher proportion of patients in the HBR group received clopidogrel and oral anticoagulants［76.89%(1 131/1 471) vs 63.22%(10 691/16 911), 5.71%(84/1 471) vs 1.45%(246/16 911)］, and a lower proportion received ticagrelor［16.38%(241/1 471) vs 28.45%(4 812/16 911)］［the absolute values of standardized mean difference (SMD) between groups ＞0.2］. The hospitalization times of patients in the HBR group were longer than those in the non-HBR group ［4(2,5)d vs 3(2,4)d］(the absolute values of SMD between groups ＞0.2). Compared with the non-HBR group, the HBR group had a higher proportion of death, bleeding, and recurrent myocardial infarction events, but the absolute values of SMD did not exceed 0.2, which was a small difference. Conclusion HBR can significantly affect the drug application of PCI in ACS patients and lead to poor prognosis. HBR patients should be treated according to the current guidelines, actively evaluate and individualized antithrombotic therapy to improve the prognosis.