Gastrointestinal bleeding in high risk survivors of myocardial infarction: the VALIANT Trial
Gastrointestinal bleeding in high risk survivors of myocardial infarction: the VALIANT Trial
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DOI：
10.1093/eurheartj/ehp256
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发表时间：
2009-09-01
影响因子：
39.3
通讯作者：
Solomon, Scott D.
中科院分区：
文献类型：
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作者：
Moukarbel, George V.;Signorovitch, James E.;Solomon, Scott D.
胃肠道(GI)出血的风险限制了抗血小板和抗凝药物的使用。心肌梗死后(MI)患者消化道出血的危险因素尚未很好地确定。我们试图确定急性心肌梗死后胃肠道出血的危险因素。急性心肌梗死试验(VALIANT)招募了14 703名心肌梗死后左心功能不全和/或心力衰竭患者，并对他们进行了中位数24.7个月的跟踪调查。在目前的二次分析中，从VALIANT严重不良事件数据库中确定了从基线到首次胃肠道出血的时间。在基线和随访期间，从病史、人口学、临床资料和用药等方面探讨了潜在的危险因素。我们还探讨了胃肠道出血的发生与随后死亡率之间的关系。在随访期间，98名患者(0.7%)发生了严重的消化道出血事件。这些患者年龄较大，有更多的合并症，更有可能服用额外的抗血小板药物，左室收缩和肾功能较差。Kaplan-Meier估计6个月时胃肠道出血率为0.37%(95%可信区间为0.27~0.47)。在多变量Cox模型中，双重抗血小板治疗是胃肠道出血最有力的预测因素，调整后的风险比为3.18(95%可信区间为1.91-5.29)。其他预测因素包括非白人种族、酗酒史、年龄增加、纽约心脏协会分级更差、抗凝治疗、糖尿病、估计肾小球滤过率较低以及男性。胃肠道出血与死亡风险增加相关[调整风险比2.54(95%可信区间1.66-3.89)]。根据MI，临床特征可以识别胃肠道出血风险增加的患者。双重抗血小板药物的使用似乎是最深刻的危险因素。这些患者是否会从胃肠道预防治疗中受益尚不清楚。
The risk of gastrointestinal (GI) bleeding limits the use of antiplatelet and anticoagulant drugs. Risk factors for GI bleeding in post- myocardial infarction (MI) patients have not been well defined. We sought to identify risk factors for GI bleeding in patients following MI.The VALsartan In Acute myocardial iNfarcTion trial (VALIANT) enrolled 14 703 post-MI patients with left ventricular dysfunction and/or heart failure and followed them for a median of 24.7 months. In the present secondary analysis, times from baseline to first GI bleeding were identified from the VALIANT serious adverse event database. Potential risk factors were explored from medical history, demographics, clinical profile, and medications, both at baseline and during follow-up. We also explored the relationship between the occurrence of GI bleeding and subsequent mortality. During follow-up, 98 (0.7%) patients had a serious GI bleeding event. These patients were older, had more comorbidities, were more likely to be taking additional antiplatelet drugs, and had worse left ventricular systolic and renal function. The Kaplan-Meier estimated rate of GI bleeding at 6 months was 0.37% (95% CI 0.27-0.47). In a multivariable Cox model, dual antiplatelet therapy was the most powerful predictor of GI bleeding, with an adjusted hazard ratio of 3.18 (95% CI 1.91-5.29). Other predictors were non-white race, history of alcohol abuse, increasing age, worse New York Heart Association class, anticoagulant therapy, diabetes, lower estimated glomerular filtration rate, and male sex. Gastrointestinal bleeding was associated with increased risk of death [adjusted hazard ratio 2.54 (95% CI 1.66-3.89)].Following MI, clinical characteristics can identify patients with increased risk of GI bleeding. The use of dual antiplatelet agents appears to be the most profound risk factor. Whether these patients would benefit from GI prophylaxis therapy remains unknown.