皮肤冠状动脉干预后的血液抽取,流体输入和出血事件
Meghana Iyer1, Ankur Kalra2, Khaled Ziada3
1Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
概括
患者护理的强度,包括皮肤冠状动脉干预 (PCI) 后的液体摄入和实验室抽取,显著影响出血事件. 这些因素改善了PCI后出血的预测模型,表明需要在国家报告中进行风险调整.
科学领域:
- 心脏病学 心脏病学
- 临床质量指标 临床质量指标
背景情况:
- 美国心脏病学会 (ACC) 国家心血管数据注册表 (NCDR) CathPCI注册表使用穿皮冠状动脉干预 (PCI) 72小时内的出血事件作为质量指标.
- 目前尚不清楚患者护理强度的标志物,如流体输入和实验室切术,是否会影响这些报告的PCI后出血事件.
研究的目的:
- 为了研究输入液体体积,实验室抽取数量和PCI后出血事件之间的关系.
- 评估这些护理强度标志物是否提高出血风险模型的预测能力.
主要方法:
- 对13,553个PCI手术进行了患者级观察性研究.
- 多变量逻辑回归分析了出血事件,流体输入和实验室抽样之间的关联,直到PCI后72小时.
- 通过添加这些变量来评估出血风险模型对歧视能力的改善.
主要成果:
- 总共记录了767 (5.7%) 的出血事件.
- 增加流体输入和更多的实验室抽取独立地与增加出血几率有关.
- 结合流体输入和实验室的多变量模型显著提高了预测能力 (C-统计 0.927),与单独的基线特征 (C-统计 0.858) 相比.
结论:
- 反映患者护理强度的因素,特别是液体的使用和实验室抽取的频率,显著提高了NCDRPCI后出血事件的预测.
- 在全国报告出血事件率时,应考虑实验室抽血和液体摄入的风险调整.
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