Multivariate Analysis Of Bleeding Events In Patients Presenting With Acute ST-Segment Elevation Myocardial Infarction

BACKGROUND: Primary percutaneous coronary intervention(PCI)is the most recommended reperfusion strategy of the acute ST-segment elevation myocardial infarction(STEMI).As a result of the continual application of new generations of highly effective antiplatelet as well as anticoagulant drugs and a greater number of patients with serious comorbidities(the patients are older and have more often renal insufficiency),the incidence of bleeding events in STEMI patients is increasing in the recent years,which is significantly associated with worse short-term and long-term prognosis after PCI.Therefore,how to avoid bleeding events in patients with STEMI with a balance between the bleeding events and ischemic events becomes the focus of attention of cardiology clinicians.METHODS: This retrospective cohort study included 293 STEMI patients who had undergone primary PCI between 2012 and 2015 in the Department of Cardiology,Shanghai Ruijin Hospital.All the patients had received emergency coronary angiography and detailed interrogation of history of present illness and past history,complete physical examination,laboratory blood test and echocardiography data collection.The bleeding events were defined according to the TIMI Bleeding Criterias.An antiplatelet therapy by use of aspirin in combination with clopidogrel or tigarelor during hospitalization was performed,whether to use tirofiban or not was determined by the interventional physicians.We will disable or reduce the relevant drug dose when the clinical bleeding event occurs according to clinical manifestations and clinician’s experiences.The characteristics of all the clinical information were compared between the bleeding group and the non-bleeding group.Results: The incidence of the bleeding events was 7.85% in patients with STEMI at Ruijin Hospital,with 23 patients in the bleeding group and 270 in the non-bleeding group.Compared to the non-bleeding group,patients of the bleeding group were significantly older(69±12 vs 63±13 years,P<0.05),had a lower weight(62.4±12.9 vs 71.4±14.0 kg,P<0.01),a lower BMI(21.74±3.33 vs 24.50±3.73 kg/m2,P<0.01),a worse cardiac function at admission(NT-proBNP 5000±7389 vs 1930±3581 pg/ml,P<0.01;LVEF 56±8 vs 59±7%,P<0.05),a lower glomerular filtration rate(GFR)(67±29 vs 89±24 ml/min/1.73m2,P<0.01),were more often treated by the femoral approach(23.09% vs 1.85%,P<0.01)and had a higher use of intra-aortic balloon pump(IABP)(17.39% vs 0.74%,P<0.01).There was a significant difference in intrahospital end-points(26.09% vs 1.85%,P<0.01).Four deaths(17.39%)occurred in the bleeding group,one myocardial reinfarction(4.34%)was treated with a second PCI,and four transfusions(17.39%)were performed.Five deaths(1.85%)were found in the non-bleeding group without myocardial reinfarction event.Multivariate analysis indicated that body mass index(BMI),GFR,left ventricular ejection function(LVEF),transfemoral approach were independent risky predictors for the occurrence of bleeding after primary PCI.Conclusions: STEMI patients with bleeding events were older,had a lower weight,a worse cardiac function at admission,a worse renal function,a higher proportion use of femoral approach and IABP.Body mass index,left ventricular ejection fraction,glomerular filtration rate and transfemoral approach were independent risky predictors for the occurrence of bleeding in patients with STEMI.Owing to the increase in the life expectancy of patients with coronary heart disease,the comorbidity of the patients,the continual application of new generations of highly effective antiplatelet drugs in the whole country and an increased level of the care of patients,bleeding events remain the key clinical work in the Chinese patients of cardiac vascular disease.An earlier recognition of high risky patients and a timely bleeding avoidance strategy will improve the clinical short and long term prognostic of these patients.