A Study Of Risk Factors For Nosocomial Bleeding After Percutaneous Coronary Stent Implantation Based On Real World Data

Objective:1.To investigate the incidence and types of nosocomial bleeding after percutaneous coronary stent implantation in a realistic clinical environment.2.To analyze the risk factors of nosocomial bleeding after percutaneous coronary stent implantation,and to propose targeted bleeding prevention strategies from the medical and nursing levels.Methods:1.This study is a single-center,historical cohort study based on a real-world study model.The structured data of patients undergoing percutaneous coronary stent implantation from January 1,2020 to September 30,2021 in a grade Ⅲ,Class A general hospital in Nanchong city were captured by standardized terms and international classification of diseases codes,including:Clinical electronic medical record data,laboratory data,nursing records and other data,using information technology to link,classify,preliminary treatment of the original data,converting real world data into real world evidence,to build the special disease data set of patients with coronary stent implantation.2.Postoperative nosocomial bleeding was used as the outcome index,and diabetes was used as the matched grouped variable.The propensity score matching method was used to control confounding factors,chi-square test and multivariate logistic regression were used to analyze the risk factors of bleeding,and ROC curve analysis was used to test the predictive efficacy ofBARTHEL score for bleeding.Results:1.A total of 822 patients were included in this study,and 120 patients(14.6%)had bleeding outcome,in which gastrointestinal bleeding accounted for 50.0%of the total bleeding.2.A total of 259 pairs were matched successfully.Regression results showed that age≥75 years(Z=2.721,P<0.05),BMI<18.5(Z=3.157,P<0.05),smoking(Z=2.458,P<0.05),complicated digestive tract diseases(Z=2.007,P<0.05),heart failure(Z=2.572,P<0.05),renal insufficiency(Z=3.722,P<0.05),complex coronary artery(Z=4.159,P<0.05),thrombocytopenia(Z=3.660,P<0.05),abnormal APTT(Z=2.662,P<0.05)and positive BARTHEL(Z=2.610,P<0.05)were independent risk factors for bleeding after PCI.Diabetes(P>0.05)was not an independent risk factor for bleeding after PCI.ROC curve analysis showed that the area under the curve for BARTHEL score to predict bleeding outcome was 0.702(P<0.001,95%CI 0.651-0.754),the specificity was 0.625,the sensitivity was 0.680,and the optimal threshold score was 65 points.Conclusions:1.The nosocomial bleeding rate after PCI in this hospital is at a high level,among which gastrointestinal bleeding is the most common type of bleeding.2.Age≥75 years,Body Mass Index(BMI)<18.5,smoking,digestive tract diseases,heart failure,renal insufficiency,complex coronary arteries,thrombocytopenia,abnormal APTT,and positive BARTHEL were independent risk factors for postoperative bleeding;Diabetes is not an independent risk factor for bleeding after PCI.Baseline BARTHEL score ≤65 May be a predictor of PCI bleeding.3.In clinical nursing practice,the principle of tertiary prevention should be followed to identify people with high blood risk at an early stage and adopt effective stratified prevention strategies to prevent the occurrence and development of bleeding after PCI.