Incidence, Predictors, And Clinical Impact Of Maior Bleeding After Percutaneous Coronary Intervention

Background:Coronary atherosclerotic heart disease is a common and frequently-occurring heart disease. With the improvement of people's living standards, the Incidence of this disease is increasing, this disease has become the number one killer to people's health. Since the first percutaneous transtuminal coronary angioplasty (PTCA) was successfully performed in 1979, breakthrough has been made in the field of percutaneous coronary intervention which has become an important and major method for the treatment of coronary heart disease. Because PCI procedures are carried out under the heparin administration, and, a variety of anticoagulant and antiplatelet therapy are used after PCI in order to prevent acute and subacute stent thrombosis, patients who received PCI procedure are in higher risk for localizable and systemic bleeding complications. Once the bleeding complication happen, the treatment will be in the very difficult sutuation.. The use of these medicines can probably cause the danger of bleeding over all or part of the body to patients, and once bleeding happens, it will bring conflict to the treatment of patients. Once more, a few of oversea studies have shown that major bleeding was an independent predictors of 30 days mortality and 1 year cardiovascular events in patients who received the PCI. There is fewer relevant research at home, and because there are differences between medication habits, dose and races at home and abroad, we made this retrospective analysis in single center, in the hope of making a better research on the correlation between major bleeding and prognosis in domestic patients with coronary heart disease.Objective:To study the incedence and risk factors of major bleeding complication after percutaneous coronary intervention, and the correlation between the happening of major bleeding and major adverse cardiac event.Subjects and Method:We recruied 1119 patients who have undergone the operation of percutaneous coronary intervention in cardiology department of Changhai Hospital from December 2007 to July 2009 and analyzed their medical record data including the basic information, past medical history, results of laboratory examination, operation data of intervention, drug usage after operation, major bleeding and major adverse cardiac event happened in hospital of patients. We followed-up these patients by phones or letters, make a detail record of out-of-hospital major bleeding, and the time when it happened and the happening time of major adverse cardiac event. We did statistic analysis by using the software SPSS 18.0, calculated the incidence rate of major bleeding and the proportion of various types of bleeding; calculation data was expressed in x±s (normal distribution), or median (abnormal distribution), analyzed the risk factors of major bleeding and major adverse cardiac event by using logistic regression analysis, and did survival analysis of the bleeding group and no-bleeding group.Results:The total number of chosen percutaneous coronary intervention patients in our hospital is 1119. There are 98 cases of major bleeding, the incidence rate is 8.8%. Logistic regression analysis shows that, in the basic clinical data, increase of old age (OR= 1.080,95%CI:1.051-1.111, P< 0.0001), female (OR=2.264,95% CI:1.329-3.858, P= 0.003), medical history of gastric disease (OR=2.533,95% CI:1.155-5.556, P= 0. 020), the history of percutaneous coronary intervention (OR=2.400,95% CI:1.408-5.498, P= 0.038), usingⅡbⅢa receptor antagonist (OR=11.615,95% CI:6.389-21.117, P <0.001)and TnI (OR=1.015,95% CI:1.005-1.026, P= 0.003) are independent risk factors of major bleeding. In operating factors, sheath size (OR=1.689,95% CI: 1.072-2.663, P=0.024), the increase of balloon dilation times (OR=1.149,95% CI: 1.079-2.223, P<0.001) and using arterial puncture closing devices (OR=4.784,95% CI: 1.376-16.633, P=0.014) are independent risk factors of major bleeding.3. Major bleeding (OR=19.165,95% CI:11.610-31.634, P=0.000), increase of age (OR=1.037,95% CI: 1.018-1.057, P<0.001), emergency operation (OR=1.566,95% CI:1.017-2.412, P=0. 042) and implanting long stents (OR=1.945,95% CI:1.023-3.146, P=0.007) are independent risk factors of major adverse cardiac event.4. Survival examination shows significant differences in survival rate between the bleeding group and no-bleeding group (p<0.001). Kaplan-Meier survival curve shows that compared with no-bleeding group, the survival curve of bleeding group is significantly lower than that of no-bleeding group.Conclusion:The total rate of major bleeding after PCI is 8.8%. Aged, femal, having the history of gastric disease or percutaneous coronary intervention, usingⅡbⅢa receptor antagonist, TnI,large size of sheath, the increase of balloon dilation times and using vascular closure device are independent risk factors of major bleeding. Major bleeding, aged, emergency operation, and implanting long stents are independent risk factors of major adverse cardiac event. The survival rate of bleeding group is significantly lower than that of no-bleeding group, and the prognosis of bleeding group is worse than that of no-bleeding group.