经皮肤冠状动脉干预后出血事件和住院死亡率之间的关联
Adnan K Chhatriwalla1, Amit P Amin, Kevin F Kennedy
1Department of Biostatistics, Saint Luke’sMid America HeartInstitute, Kansas City, Missouri 64111, USA.
JAMA
|March 14, 2013
概括
穿皮冠状动脉干预 (PCI) 后的出血显著增加了住院死亡风险,占死亡人数的12.1%. 这凸显了PCI患者出血风险管理的关键需求.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 公共卫生 公共卫生
背景情况:
- 经皮冠状动脉干预 (PCI) 后出血是常见的并发症.
- 后PCI出血与较高的发病率,增加的医疗保健费用和不清楚的死亡率相关.
- 缺乏PCI后与出血相关的死亡率的国家代表性数据.
研究的目的:
- 调查PCI后出血事件和住院死亡率之间的关联.
- 估计与流血相关的住院死亡人数的可归因风险,风险差异和伤害所需人数 (NNH).
主要方法:
- 从CathPCI注册表 (2004-2011) 中分析了3,386,688个PCI程序.
- 根据人口,临床和程序变量调整的可归因于人口的风险计算.
- 倾向匹配分析以确定NNH与出血相关的死亡率.
主要成果:
- 严重出血发生在1.7%的PCI手术中,与12.1%的人口可归因的死亡风险相关.
- 在倾向匹配的队列中,严重出血增加了住院死亡率 (5.26%对1.87%,NHN=29).
- 访问部位和非访问部位出血都增加了死亡率,非访问部位出血的NNH较低 (16对117).
结论:
- 后PCI出血事件与增加的住院死亡率有显著的关联.
- 在PCI后,大约12.1%的住院死亡是由于出血并发症造成的.
- 有效的出血风险管理对于改善PCI患者的治疗结果至关重要.
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