Analysis Of Relationship Between The HAS-BLED System And Ami After Receiving Emergency PCI

Background : Acute myocardial infarction is a serious condition of coronary atherosclerotic heart disease,which can be complicated by malignant arrhythmia,cardiogenic shock or acute heart failure,and even sudden cardiac arrest,which is one of the most common causes of death worldwide for people with critical illness.The HAS-BLED system was initially created to predict oral anticoagulant related bleeding in patients with atrial fibrillation,and studies have shown that the system could be used to predict the risk of bleeding in patients with acute coronary syndrome receiving anticoagulant therapy.At present,GRACE system,CRUSADE system and TIMI system are often used to analyze the clinical prognoses of acute myocardial infarction.These systems are complex,which is not widely used to clinical application.Now the HAS-BLED scoring system gradually expanded its use of the field,and this scoring system is easier to calculate.Recently,there are few studies on the relationship between the HAS-BLED scoring system and acute myocardial infarction.The purpose of this study is to investigate the relationship between HAS-BLED scoring system and acute myocardial infarction in patients undergoing emergency PCI.Objective:To research the relationship between HAS-BLED scoring system in hospital and acute myocardial infarction(AMI)in patients undergoing PCI In terms of Clinical datas,severe complications in hospital,coronary artery disease and prognoses within 2 years.Methods:1.As a retrospective cohort study,we selected 630 patients who were diagnosed with AMI firstly and had received PCI in the first affiliated hospital of Soochow university from January 2013 to January 2015.Patients are divided into three groups according to the HAS-BLED system score: Low score group(HAS-BLED≤1 group),Middle score group(HAS-BLED=2 group),High score group(HAS-BLED≥3 group).2.The case-control study is to collect clinical datas of enrolled patients,such as age,sex,hypertension,history of diabetes,smoking,abnormal liver function,abnormal renal function,stroke,bleeding,labile INRs(INRs>1.3),proportion of elderly and NSAIDs use,drinking history,TC,LDL-C,HDL-C,TG,Hs-CRP and so on.Patients with severe complications in hospital are collected,such as acute heart failure,malignant arrhythmia,cardiogenic shock,severe bleeding events and death.Meanwhile,informations of percutaneous coronary intervention were collected,such as the site and the number of coronary artery lesion.And also collect informations of prognoses within two years(acute myocardial infarction recurrence,malignant arrhythmia,heart failure,severe bleeding events and death).3.To compare the severe complications in hospital,percutaneous coronary intervention findings and prognoses within 2 years,and explore the relationship between HAS-BLED scoring system and them.Results:1.The age,hypertension,abnormal liver function,the elderly(>65-year-old),low density lipoprotein cholesterol(LDL-c)are statistically significant differences overall among three groups of patients(P<0.05),and there are statistically significant differences between subgroups,indicated that with the increase of scores,the patients had a higher age,higher LDL-c level,higher proportion of hypertension,abnormal liver function,and the elderly(>65-year-old).Patients with low score group had higher Hs-C reactive protein and troponin I levels,and proportion of abnormal renal function,bleeding history and alcohol consumption are higher in the patients with middle score.The ratio of woman in high score group is higher.The differences above are statistically significant.2.There is significant difference in the incidence of acute heart failure overall among three groups of patients in hospital,and there is statistical differences among the subgroups,and the AUC is 0.663(95%CI 0.602-0.704,P<0.001),indicated that with the increase of scores,patients will have a higher incidence of acute heart failure in hospital.The incidence of cardiogenic shock in hospital in high score group was higher.The differences above are statistically significant.3.There is significant difference in the incidence of LAD overall among three groups of patients,and there are statistical differences among the subgroups,and the AUC is 0.637(95%CI 0.593-0.681,P<0.001),indicated that with the increase of scores,patients will have a higher incidence of LAD.The low score group with a higher incidence of RCA,the middle score group with a higher incidence of LCX,the high score group with a higher incidence of double branches lesion and a lower incidence of single vessel lesion,the differences above are statistically significant.4.The prognoses of the patients within 2 years: There is significant difference in the incidence of HF and death within 2 years overall among three groups of patients,and there are statistical differences among the subgroups,and their AUC are 0.611(95%CI 0.562-0.661,P<0.001)and 0.616(95%CI 0.588-0.673,P<0.001)respectively.HAS-BLED system has a similar ability with GRACE system by comparing the area under the ROC curves(P is 0.452),indicated that with the increase of scores,patients will have a higher incidence of HF and death within 2 years.The incidence of acute myocardial infarction recurrence within 2 years in high score group was higher.Conclusion:1.The admission HAS-BLED score can assess the risk of acute heart failure in hospital,and subsequent HF and death within 2 years for AMI patients undergoing emergency PCI surgery.2.HAS-BLED system is similar with GRACE system in predicting death within 2 years AMI patients undergoing emergency PCI surgery.