Impact of Bleeding on Quality of Life in Patients on DAPT: Insights From TRANSLATE-ACS.
Impact of Bleeding on Quality of Life in Patients on DAPT: Insights From TRANSLATE-ACS.
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DOI：
10.1016/j.jacc.2015.10.034
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发表时间：
2016-01-05
影响因子：
24
通讯作者：
Cohen DJ
中科院分区：
文献类型：
--
作者：
Amin AP;Wang TY;McCoy L;Bach RG;Effron MB;Peterson ED;Cohen DJ
急性心肌梗死（AMI）后推荐延长双联抗血小板治疗（DAPT）以减少缺血事件，但与大出血和小出血的发生率增加相关。本研究旨在确定当代DAPT发生的经皮冠状动脉介入治疗（PCI）后出血的发生率及其对生活质量（QOL）的影响。我们研究了2010年4月至2012年9月期间接受PCI治疗并存活出院的9，290例AMI患者。根据出血学术研究联盟（BARC）的定义对出院后出血进行分类。主要结局是6个月欧洲QOL-5维度（EQ-5D）指数评分（健康效用的一种衡量指标）;次要结局是6个月时的EQ-5D视觉模拟量表（VAS）。在9，290例AMI患者中，出血事件发生率如下：任何BARC出血：24.2%; BARC 1：9.1%; BARC 2：13.8%; BARC 3：1.1%; BARC 4：0.03%;和BARC 5：0%。发生任何BARC出血的受试者在所有5个EQ-5D领域（活动能力、自我护理、日常活动、疼痛和焦虑）的评分较低，EQ-5D VAS和EQ-5D指数评分也较低。临床风险调整后，任何BARC出血与6个月EQ-5D指数评分（p < 0.0001）和较低的QOL（p < 0.001）独立相关。随着BARC严重程度的增加，EQ-5D指数和VAS评分均逐步下降。在因AMI接受PCI的患者中，随访期间出血与6个月效用和QOL较差相关。虽然即使是轻微出血也与健康状况和生活质量受损相关，但受损程度随出血严重程度呈阶梯式增加。
Prolonged dual antiplatelet therapy (DAPT) is recommended after an acute myocardial infarction (AMI) to reduce ischemic events but is associated with increased rates of major and minor bleeding. This study sought to determine the incidence of post-percutaneous coronary intervention (PCI) bleeding that occurs on contemporary DAPT and its impact on quality of life (QOL). We studied 9,290 AMI patients treated with PCI and discharged alive between April 2010 and September 2012. Post-discharge bleeding was categorized according to the Bleeding Academic Research Consortium (BARC) definition. The primary outcome was the 6-month Euro QOL–5 Dimension (EQ-5D) index score (a measure of health utility); a secondary outcome was the EQ-5D visual analog scale (VAS) at 6 months. Of the 9,290 patients with AMI, bleeding events occurred as follows: any BARC bleeding: 24.2%; BARC 1: 9.1%; BARC 2: 13.8%; BARC 3: 1.1%; BARC 4: 0.03%; and BARC 5: 0%. Those who experienced any BARC bleeding had lower scores across all 5 EQ-5D domains (mobility, self-care, usual activities, pain, and anxiety), as well as lower EQ-5D VAS and EQ-5D index scores. After clinical risk adjustment, any BARC bleeding was independently associated with 6-month EQ-5D index score (p < 0.0001) and lower QOL (p < 0.001). Both the EQ-5D index and the VAS score declined in a stepwise fashion with increasing BARC severity. Among patients undergoing PCI for AMI, bleeding during follow-up was associated with worse 6-month utility and QOL. Although even minor bleeding was associated with impaired health status and QOL, the degree of impairment increased in a stepwise fashion with bleeding severity.
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影响因子：
39.3
作者：
Steg, Philippe Gabriel;Huber, Kurt;Collet, Jean-Philippe
通讯作者：
Collet, Jean-Philippe
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