Risk Factors Of Bleeding Complications After Primary PCI And Its Influence On The Patients' Prognosis

Objective:We evaluate hemorrhage complications and prognosis of primary PCI,in order to prevent bleeding complications,and improve patient prognosis basis.Methods:This study was a retrospective analysis a total of 519 cases(279 cases of male,female 240 cases)were confirmed to have ST segment elevation myocardial infarction undergoing primary PCI between January 2013 to March 2015 in Yancheng First People's Hospital.These patients were categorized into two groups according to bleeding complications(n=111)and Non-bleeding complications(n=408),Data were collected retrospectively and compared between two groups,we anylyze the influence of various factors on occurrence of bleeding,discuss affecting the prediction of bleeding.After patients were discharged,incidence and survival rates and major adverse cardiac event(MACE)(death,re-PCI,myocardial infarction,stroke,coronary artery bypass grafting)were compared on the 12-month following up.All data are analyzed by SPSS19.0 software,P <0.05 was statistically significant.Results:1.Bleeding group compared not bleeding group: Two groups clinical data of gender,age,hypertension,smoking,history of taking anti-platelet drugs,whether multi-vessel disease,coronary thrombolysis in PCI process,arrhythmia,surgery with or without stenting are no statistically significant difference;Two groups clinical data of diabetes,history of gastrointestinal disease,application GPIIb/IIIa drugs,croquet time,PCT,CRP,PT,glycated hemoglobin level were significantly different.2.Logistic regression analysis found that croquet time(OR=1.2,95%CI:1.1-1.3,P=0.045),CRP(OR=4.9,95%CI:3.3-6.7,P=0.001),PT(OR=1.8,95%CI:1.2-3.2,P=0.041),glycated hemoglobin levels(OR=2.5,95%CI:1.6-3.4,P=0.033),PCT(OR=3.3,95%CI:1.7-5.1,P=0.011),digestive diseases time(OR=4.1,95%CI:2.5-5.7,P=0.003)of bleeding events in patients with the greatest impact and all risk factors are independent of each other.3.Total score of hemorrhage risk factors and bleeding events rates have a linearly related;MACE incidence(13.51% VS 14.22%,P=0.34);(15.32% VS 15.44%,P=0.28);(16.22% VS 16.67%,P=0.12),and survival rate(97.30% VS 97.05%,P=0.36);(3.69% VS 93.14%,P=0.41);(90.99% VS 90.92%,P=0.22)is no difference between bleeding and non-bleeding group in 1,2,3 months and survival of almost(MACE),and 6 and 12 months hemorrhage patients significantly increased incidence of MACE(26.13% VS 17.40%,P=0.03);(34.23% VS 21.57%,P=0.01)and significantly decreased survival(83.78% VS 90.44%,P=0.02);(75.68% VS 85.29%,P<0.01).4.Receiver operating characteristic curve for combined indicated that the cutoff value of CRP 93.17 mg/L,PCT 2.2 ng/ml,digestive tract disease history of 7.4 years,had the best performance in predicting bleeding complications,diagnostic sensitivity and specificity events were 82.7% and 81%.Conclusion:1.Effect factors of primary PCI in patients with bleeding include: diabetes,history of gastrointestinal disease,application GPIIb/IIIa drugs,croquet time,PCT,CRP,PT,glycated hemoglobin level.2.The primary PCI in patients with bleeding risk score value of bleeding events rates were significantly postive correlated.3.Logistics regression analysis showed that the single factors,croquet time,CRP,PT,glycated hemoglobin levels,PCT,digestive diseases time in patients with the greatest impact on the occurrence of bleeding events,and are independent factors.4.When CRP threshold 93.17 mg/L,PCT 2.2 ng/ml,digestive tract disease history of 7.4 years,diagnostic sensitivity and specificity of bleeding events were 82.7% and 81%.5.Bleeding group's MACE incidence and mortality significantly increased in 6 and 12 months.