Učestalost, prediktori i prognozni značaj krvarenja kao komplikacije primarne perkutane koronarne intervencije

  • Dragan M Matić Clinic for Cardiology,Clinical Center of Serbia, Belgrade, Serbia
  • Milika R Ašanin Clinic for Cardiology,Clinical Center of Serbia, Belgrade, Serbia Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Sanja Dj Stanković Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
  • Igor B Mrdović Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Jelena M Marinković Institute for Medical Statistics and Health Research, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Nikola I Kočev Institute for Medical Statistics and Health Research, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Nebojša M Antonijević Clinic for Cardiology Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Marija M Marjanovic Clinic for Cardiology Clinical Center of Serbia, Belgrade, Serbia
  • Zorica I Nešić Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Milica S Prostran Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Goran R Stankovic Clinic for Cardiology,Clinical Center of Serbia, Belgrade, Serbia Faculty of Medicine, University of Belgrade, Belgrade, Serbia
DOI: https://doi.org/10.2298/5564
Ključne reči: angioplasty, transluminal, percutaneous coronary||, ||angioplastika, translumenska, perkutana, koronarna, postoperative complications||, ||postoperativne komplikacije, hemorrhage||, ||krvarenje, risk factors||, ||faktori rizika, prognosis||, ||prognoza, mortality||, ||mortalitet, fibrinolytic agents||, ||fibrinolitici,

Sažetak


Uvod/Cilj. Podaci o krvarenju kao komplikaciji perkutanih koronarnih intervencija (PCI) češće se dobijaju putem randomizovanih kliničkih studija kod bolesnika sa akutnim koronarnim sindromima (ACS), a ređe putem popisa i registara bolesnika sa infarktom miokarda sa ST-elevacijom (STEMI). Cilj ove studije bio je da se ispita učestalost, prediktori i prognozni značaj velikog intrahospitalnog krvarenja kod populacije neselektovanih bolesnika sa STEMI lečenih metodom primarne PCI. Metode. U studiju su bili uključeni svi po redosledu primljeni bolesnici sa STEMI, podvrgnuti primarnoj PCI u velikom tercijarnom zdravstvenom centru u periodu između januara 2005. i jula 2009. godine. Veliko krvarenje definisano je prema kriterijumima studije Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO). Ispitivali smo povezanost između velikog krvarenja nastalog tokom hospitalizacije i smrtnog ishoda, kao i glavnih neželjenih kardijalnih događaja (major adverse cardiac events – MACE) kod bolesnika lečenih metodom primarne PCI. Primarni ciljevi bili su bolnički i 6-mesečni mortalitet i glavni neželjeni kardijalni događaji. Rezultati. Od 770 bolesnika lečenih metodom primarne PCI, veliko krvarenje tokom hospitalizacije nastalo je kod 32 (4,2%) bolesnika. Nezavisni prediktori velikog krvarenja bili su odmaklo životno doba (≥ 65 godina), ženski pol, anemija i povećan broj leukocita na prijemu, kao i zastojna srčana insuficijencija klase Killip II–IV. Učestalost bolničke i 6-mesečne smrtnosti i MACE bila je više nego 2,5 puta veća kod bolesnika koji su imali veliko krvarenje nego kod bolesnika bez krvarenja. Veliko krvarenje bilo je prediktor 6-mesečnog MACE, nezavisno od nekoliko faktora rizika (prethodni MI, prethodni PCI, dijabetes melitus i hipertenzija), (OR 3,02; 95% CI 1,20 do 7,61; p = 0,019), ali nije bilo nezavisan prediktor MACE u modelu korigovanom za sve faktore rizika. Zaključak. Bolesnici odmaklog životnog doba, ženskog pola, sa anemijom i povećanim brojem leukocita na prijemu kao i Killip klasom II–IV su u posebno povećanom riziku od krvarenja posle primarne PCI. Krvarenje je udruženo sa nepovoljnim ishodom i može biti značajan marker bolesnikovog nestabilnog stanja, ali nije u potpunosti nezavisan prediktor smrtnosti i MACE.

Reference

Rao SV, O'Grady K, Pieper KS, Granger CB, Newby L, Mahaffey KW, et al. A comparison of the clinical impact of bleeding measured by two different classifications among patients with acute coronary syndromes. J Am Coll Cardiol 2006; 47(4): 809−16.

Wallace TW, Rao SV. The challenge of defining bleeding among patients with acute coronary syndromes. Clin Cardiol 2007; 30(10 Suppl 2): II16−23.

Steinhubl SR, Kastrati A, Berger PB. Variation in the definitions of bleeding in clinical trials of patients with acute coronary syndromes and undergoing percutaneous coronary interven-tions and its impact on the apparent safety of antithrombotic drugs. Am Heart J 2007; 154(1): 3−11.

Stone GW, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, et al. Bivalirudin during primary PCI in acute myo-cardial infarction. N Engl J Med 2008; 358(21): 2218−30.

Mehran R, Lansky AJ, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, et al. Bivalirudin in patients undergoing primary an-gioplasty for acute myocardial infarction (HORIZONS-AMI): 1-year results of a randomised controlled trial. Lancet 2009; 374(9696): 1149−59.

Fuchs S, Kornowski R, Teplitsky I, Brosh D, Lev E, Vaknin-Assa H, et al. Major bleeding complicating contemporary primary percutaneous coronary interventions-incidence, predictors, and prognostic implications. Cardiovasc Revasc Med 2009; 10(2): 88−93.

Eikelboom JW, Mehta SR, Anand SS, Xie C, Fox KA, Yusuf S. Adverse impact of bleeding on prognosis in patients with acute coronary syndromes. Circulation 2006; 114(8): 774−82.

Manoukian SV, Feit F, Mehran R, Voeltz MD, Ebrahimi R, Hamon M, etal. Impact of major bleeding on 30-day mortality and clinical outcomes in patients with acute coronary syndromes: an analysis from the ACUITY Trial. J Am Coll Cardiol 2007; 49(12): 1362−8.

Van de Werf F, Ardissino D, Betriu A, Cokkinos DV, Falk E, Fox KA, et al. Management of acute myocardial infarction in pa-tients presenting with ST-segment elevation. Eur Heart J 2003; 24(1): 28−66.

The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993;329(10): 673−82.

Thygesen K, Alpert JS, White HD. Universal definition of myo-cardial infarction. Eur Heart J 2007; 28(20): 2525−38.

Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Car-diology. Eur Heart J 2008; 29(23): 2909−45.

Silber S, Albertsson P, Avilés FF, Camici PG, Colombo A, Hamm C, et al. Guidelines for percutaneous coronary interventions. The

Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur Heart J 2005; 26(8): 804−47.

Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, et al.. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 2007; 115(17): 2344−51.

Kinnaird TD, Stabile E, Mintz GS, Lee CW, Canos DA, Gevorkian N, et al. Incidence, predictors, and prognostic implications of bleeding and blood transfusion following percutaneous coro-nary interventions. Am J Cardiol 2003; 92(8): 930−5.

Nikolsky E, Mehran R, Dangas G, Fahy M, Na Y, Pocock SJ, et al. Development and validation of a prognostic risk score for major bleeding in patients undergoing percutaneous coronary intervention via the femoral approach. Eur Heart J 2007; 28(16): 1936−45.

Mehran R, Pocock SJ, Nikolsky E, Clayton T, Dangas GD, Kirtane AJ, et al. A risk score to predict bleeding in patients with acute coronary syndromes. J Am Coll Cardiol 2010; 55(23): 2556−66.

Palmerini T, Mehran R, Dangas G, Nikolsky E, Witzenbichler B, Guagliumi G, et al. Impact of leukocyte count on mortality and bleeding in patients with myocardial infarction undergoing primary percutaneous coronary interventions: analysis from the Harmonizing Outcome with Revascularization and Stent in Acute Myocardial Infarction trial. Circulation 2011; 123(24): 2829−37.

Manoukian SV, Voeltz MD, Eikelboom J. Bleeding complications in acute coronary syndromes and percutaneous coronary intervention: predictors, prognostic significance, and paradigms for reducing risk. Clin Cardiol 2007; 30(10 Suppl 2): 4−34.

Chew DP, Lincoff A, Gurm H, Wolski K, Cohen DJ, Henry T, et al. Bivalirudin versus heparin and glycoprotein IIb/IIIa inhibition among patients with renal impairment undergoing percutane-ous coronary intervention (a subanalysis of the REPLACE-2 trial). Am J Cardiol 2005; 95(5): 581−5.

Suh J, Mehran R, Claessen BE, Xu K, Baber U, Dangas G, et al. Impact of in-hospital major bleeding on late clinical outcomes after primary percutaneous coronary intervention in acute my-ocardial infarction the HORIZONS-AMI (Harmonizing Out-comes With Revascularization and Stents in Acute Myocardial Infarction) tr. J Am Coll Cardiol 2011; 58(17): 1750−6.

Mrdovic I, Savic L, Krljanac G, Asanin M, Lasica R, Djuricic N, et al. Simple risk algorithm to predict serious bleeding in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: RISK-PCI bleed-ing score. Circ J 2013; 77(7): 1719−27.

Objavljeno
2015/11/02
Broj časopisa
Vol. 72 Br. 7 (2015)
Rubrika
Originalni članak