The prognosis of elderly patients with acute coronary syndromes combined with upper gastrointestinal hemorrhage during hospitalization following percutaneous coronary intervention / 中华老年医学杂志

ABSTRACT

Objective:To assess the future risk of bleeding events and ischemic events in a two-year follow-up of elderly patients with acute coronary syndromes(ACS)who experienced upper gastrointestinal bleeding during hospitalization, and to analyze the related factors for the recurrence.Methods:This was a retrospective case-control study.Elderly ACS patients who underwent percutaneous coronary intervention(PCI)in Beijing Hospital from January 1, 2015 to December 31, 2018 were continuously included.According to whether upper gastrointestinal bleeding occurred during hospitalization, they were divided into the bleeding group(n=51)and the control group(n=2 834). Baseline data were compared between the two groups.The incidence of major adverse cardiovascular events(MACE)and the recurrence of bleeding defined by the Bleeding Academic Research Consortium(BARC)consensus classification were monitored during the 2-year followed-up.Related factors for clinically significant bleeding events(BARC type 2, 3 and 5)were analyzed.Results:The median bleeding time in the bleeding group was 3.3 days after PCI, and the main cause was gastroduodenal ulcer(43 cases, 84.3%). Compared with the control group, patients in the bleeding group had a lower body mass index, a higher proportion of patients with a history of atrial fibrillation, chronic kidney disease, peptic ulcer, ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction, higher usage rates of ticagrelor and oral anticoagulants, a lower usage rate of proton pump inhibitor(PPI), a higher proportion of patients with coronary artery disease involving ≥ 2 vessels, higher GRACE scores, higher usage rates of tirofiban and aspiration catheters and a lower complete revascularization rate( P<0.05). Patients were followed up for(22.4±1.5)months.Compared with the control group, the incidence of MACE(19 cases or 37.3% vs.698 cases or 24.6%, HR=1.655, 95% CI 1.026-2.673, χ 2=4.513, P<0.05)and the recurrence of clinically significant bleeding(BARC type 2, 3 and 5)(10 cases or 19.6% vs.283 cases or 10.0%, HR=2.242, 95% CI 1.209-4.157, χ2=5.083, P<0.05)increased in the bleeding group.Logistic multivariate regression analysis showed that age ≥70 years( RR=1.813, 95% CI 1.021-3.219), chronic kidney disease ≥ stage 2( RR=1.623, 95% CI 1.196-2.202), history of peptic ulcer( RR=2.152, 95% CI 1.156-4.006), ticagrelor( RR=2.014, 95% CI 1.253-3.237), and oral anticoagulants( RR=1.352, 95% CI 1.032-1.771)were independent risk factors for clinically significant bleeding(BARC type 2, 3 and 5), and PPI was a protective factor( RR=0.573, 95% CI 0.345-0.952). Conclusions:A history of upper gastrointestinal bleeding in elderly patients with ACS during hospitalization can increase the recurrence risk of clinically significant bleeding and MACE events in subsequent two years.Advanced age, chronic kidney disease ≥stage 2, a history of peptic ulcer, and preoperative use of ticagrelor and oral anticoagulants are independent risk factors for the recurrence risk of clinically significant bleeding, and PPI can decrease the recurrence risk of bleeding.