| Objective:To explore the acute coronary syndrome(ACS)undergoing coronary stent implantation in patients with oral dual antiplatelet therapy(DAPT)on the influence factors of gastrointestinal bleeding,under different influencing factors of prevention,treatment and prognosis.Methods:Retrospective selection in June 2013 to January 2017 in the second people's hospital of Yunnan province cardiovascular medicine department with acute coronary syndrome patients which all cases of 1879 coronary stent implantation.Oral dual antiplatelet therapy in our hospital continuous follow-up and conforms to the cases included in the standard of 1346 cases,which have 42 cases of gastrointestinal bleeding cases.Select the 42 cases of gastrointestinal bleeding group.1304 cases have no bleeding as a group.Cases collected data including age,gender,body mass index(BMI),smoking history,hypertension,diabetes,hyperlipidemia,preious myocardial infarction,stroke,hemoglobin,proton pump inhibitors(PPI),heart failure,oral dual antiplatelet therapy,ACS classification,BARC-classified bleeding,Forrest level,gastrointestinal bleeding treatment.According to whether gastrointestinal bleeding,it can be divided into no bleeding and bleeding group,and analyzes its every relationship with gastrointestinal bleeding.According to the different dual antiplatelet therapy divide into aspirin?clopidogrel group,aspirin?ticagrelor,compare the incidence of gastrointestinal bleeding under different dual antiplatelet therapy and analyzes its reason.According to BARC-classified bleeding can be divided into below grade 3 group,grade 3 and over group,compare three types of ACS patients in the two groups the incidence and cure rate of bleeding.Gastrointestinal bleeding group according to the treatment plan is divided into internal medicine conservative treatment group and endoscopic treatment,analysis the curative effect of two groups of treatment and outcome.Resulte:1.The basic information of bleeding and bleeding group by statistical inspection,found that age,gender,diabetes,smoking,previous myocardial infarction,proton pump inhibitors,heart failure distribution difference between the two groups have statistical significance(P<0.05),of which age,male,has a history of diabetes,smoking history,previous myocardial infarction,heart failure,patients with low proton pump inhibitor use in bleeding group accounts for the proportion of high,and BMI,hypertension,cerebral apoplexy,hyperlipidemia distribution between the two groups have no difference(P>0.05).2.Single factor on the distribution of differences between two groups of variables:age,gender,diabetes,smoking,previous myocardial infarction,proton pump inhibitors,heart failure into Logistic regression(LR)analysis,found that age(P<0.001),diabetes(P=0.007),previous myocardial infarction(P<0.001),and heart failure(P=0.006)is a risk factor for bleeding(OR value is greater than 1),and the use of proton pump inhibitors(P=0.001)is the protection factor of gastrointestinal bleeding,temporarily don't consider other factors is a risk factor for gastrointestinal bleeding(P>0.05).3.Aspirin and clopidogrel group and with aspirin and ticagrelor group,the incidence of gastrointestinal bleeding between the two groups by chi-square test,there was no statistically significant different(P>0.05).4.Bleeding and no bleeding group in each type of ACS by chi-square test,there was no statistically significant difference(P>0.05).5.The bleeding group according to the BARC classification of bleeding was classified into under grade 3?grade 3 and over group.There were 34 cases under grade 3 group,33 cases were treated well after treatment,1 case died of invalid treatment.Grade 3 and over group 8 cases,after treatment,6 cases were improved and discharged,2 cases died of treatment.Two groups of bleeding on the treatment efficiency by chi-square difference was statistically significant(P>0.05).Due to part classification above type 3 cases less,cases will STEMI and NSTEMI merged into acute myocardial infarction(mi),type of ACS type in part of bleeding points regularly test statistic difference was statistically significant(P<0.05).6.According to treatment can be divided into internal medicine conservative treatment group,the endoscopic and internal medicine conservative treatment group.To compare two treatments,the difference was statistically significant.(P<0.05)Conclusions:1.Age,diabetes mellitus,previous myocardial infarction,heart failure is the ACS patients with stenting DAPT merged independent risk factors for gastrointestinal bleeding,use of proton pump inhibitors are the protective factors.2.The ACS patients undergoing stenting DAPT merger gastrointestinal bleeding from BARC-classified bleeding below grade 3 more of these.Type 3 bleeding in unstable angina combined with greater incidence of gastrointestinal bleeding,bleeding in acute myocardial infarction combined type 3 or more high incidence of gastrointestinal bleeding.3.ACS patients with stenting undergoing taking DAPT combined endoscopic and internal medicine conservative treatment curative effect is superior to the traditional medical treatment of gastrointestinal bleeding. |
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