Objective To investigate the clinical characteristics and prognosis of patients with gastrointestinal bleeding after acute myocardial infarction(AMI). Methods 419 AMI patients were divided into control group( n = 404, patients without gastrointestinal bleeding peri-AMI phase)and GIB-post-AMI group( n = 15, patients with gastrointestinal bleeding after AMI), the clinical characteristics and combined end points of cardiovascular death and hospitalization for recurrent angina pectoris,non-deadly AMI,heart failure and stroke were analysed. Results ① Compared with control group;more patients had a history of gastrointestinal disease( 13.3％ vs 5.2％ )in GIB-post-AMI group, but no statistical difference between them( P ＞0.05 ). ② GIB-post-AMI patients had significantly lower eGFR compared with the controls (57. 1 ± 23.5 ml/min/l.73m2 vs. 74.6 ± 26.4 ml/min/l. 73m2, P ＜ 0.05 ). Logostic regression analysis with eGFR revealed that the hazard ratio for GIB-post-AMI patients was 0.975 (95％ CI: 0. 957 ～ 0. 995, P ＜ 0. 05 ), and reduced eGFR was an indelendent risk factor. ③ There were significantly fewer patients given with aspirin in GIB-post-AMI group than in control group( 66.7％ vs. 97.5％, P ＜ 0.05 ). Fewer GIB-post-AMI patients were performed percutaneous coronary intervention (PCI) and thrombolytic therapy compared with control patients, but there was no statistical difference (53.3％ vs. 76.0％, P ＞ 0.05 ). ④ The combined end points of cardiovascular death and hospitalization for recurrent angina pectoris, non-deadly AMI, heart failure and stroke in GIB-postAMI group were significantly higher than those in AMI control group(40.0％ vs. 15.3％ ,P ＜0.05 ). Conclusion Reduced eGFR is an important predicting factor for patients to develop gastrointestinal bleeding after AMI. It's difficult to take anti-platelet or revascularization treatment for patients with developing gastrointestinal bleeding after AMI,which usually has worse prognosis.%目的 分析急性心肌梗死(AMI)后消化道出血患者的临床特点及预后.方法 将419例确诊为AMI的患者分为AMI对照组(404例)和AMI后消化道出血组(15例),分析AMI后消化道出血患者的临床特点及1年心血管病死亡和因再发心绞痛、非致死性AMI、心力衰竭和中风而住院的复合终点结果.结果 ①AMI后消化道出血组患者有消化道疾病史者的比例高于AMI对照组(13.3%vs.5.2%),但差异无统计学意义(P>0.05).②AMI后消化道出血组的估测肾小球滤过率(eGFR)显著低于对照组[(57.1±23.5)Ml·min-11.73 m-2vs.(74.6±26.4)ml·min-1·1.73 m-2,P<0.05],Logostic回归分析显示,eGFR降低对AMI患者发生消化道出血的相对危险为0.975(95%CI为0.957～0.995,P<0.05).③AMI后消化道出血组阿司匹林使用率低于AMI对照组(66.7%vs.97.5%,P<0.05).AMI后消化道出血组介入或溶栓治疗的比例低于AMI对照组,但差异无统计学意义(53.3%vs.76.0%,P>0.05).④AMI后消化道出血组的1年心血管病死亡和因再发心绞痛、非致死性AMI、心力衰竭和中风而住院的复合终点明显高于AMI对照组(40.0%vs.15.3%,P<0.05).结论 eGFR降低是AMI患者发生消化道出血的重要预测因素.AMI患者发生消化道出血后常使抗血小板和冠脉再通治疗困难,多预后不良.
展开▼
