Prognostic implications of bleeding measured by Bleeding Academic Research Consortium (BARC) categorisation in patients undergoing primary percutaneous coronary intervention
Prognostic implications of bleeding measured by Bleeding Academic Research Consortium (BARC) categorisation in patients undergoing primary percutaneous coronary intervention
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DOI：
10.1136/heartjnl-2013-304564
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发表时间：
2014-01-15
期刊：
影响因子：
5.7
通讯作者：
Stankovic, Goran R.
中科院分区：
文献类型：
--
作者：
Matic, Dragan M.;Milasinovic, Dejan G.;Stankovic, Goran R.
目的探讨经皮冠状动脉介入治疗（PCI）住院患者的近期和远期死亡率与出血学术研究联盟（BARC）共识分类的出血量之间的关系。在高容量中心的预期登记中登记。根据前瞻性收集的详细临床数据重建BARC定义的出血事件。主要结局是1年时的死亡率。结果在1808例接受直接PCI的STEMI患者中，115例（6.4%）发生了BARC 2型出血。随着BARC出血严重程度的恶化，1年死亡率呈梯度增加。1年死亡率从BARC 0+ 1型的11.5%增加到BARC 3b型出血的43.5%。在对患者的人口统计学和临床特征进行多变量调整后，1年死亡的独立预测因子为BARC 3a型（HR 1.99; 95% CI 1.16 - 3.40，p=0.012）和BARC 3b型出血（HR 3.22; 95% CI 1.67 ~ 6.20，p< 0.0001）。结论本研究表明根据BARC分类定义的出血事件与直接PCI入院后1年死亡率分层相关。1年死亡率的最强预测因子是BARC 3b型出血。
Objective To investigate the relationship between inhospital bleeding as defined by Bleeding Academic Research Consortium (BARC) consensus classification and short-term and long-term mortality in unselected patients admitted for primary percutaneous coronary intervention (PCI).Methods We analysed data of all consecutive patients with ST segment elevation myocardial infarction (STEMI) admitted for primary PCI, enrolled in a prospective registry of a high volume centre. The BARC-defined bleeding events were reconstructed from the detailed, prospectively collected clinical data. The primary outcome was mortality at 1 year.Results Of the 1808 patients with STEMI admitted for primary PCI, 115 (6.4%) experienced a BARC type =2 bleeding. As the BARC bleeding severity worsened, there was a gradient of increasing rates of 1-year death. The 1-year mortality rate increased from 11.5% with BARC 0+ 1 type to 43.5% with BARC type 3b bleeding. After multivariable adjustment for demographic and clinical characteristics of patients, the independent predictors of 1-year death were BARC type 3a (HR 1.99; 95% CI 1.16 to 3.40, p=0.012) and BARC type 3b bleeding (HR 3.22; 95% CI 1.67 to 6.20, p< 0.0001).Conclusions The present study demonstrated that bleeding events defined according to the BARC classification hierarchically correlate with 1-year mortality after admission for primary PCI. The strongest predictor of 1-year mortality is the BARC type 3b bleeding.