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Patients with cardiac disease: Changes observed through last decade in out-patient clinics

World Journal of Cardiology 2013年第8期5卷 288-294页

作者： Alberto Cordero Vicente Bertomeu-Martínez Pilar Mazón Lorenzo Fácila Juan Cosín Vicente Bertomeu-gonzález Moisés rodriguez Eva Andrés Enrique Galve Iaki Lekuona jose r gonzález-juanatey Cardiology Department Hospital Universitario de San Juan Cardiology Department Hospital General de Valencia Cardiology Department Hospital Arnau de Vilano-va Cardiology Department Hospital Complejo Universitario de Santiago de Compostela research Unit Hospital Universitario 12 de Octu-bre Instituto de investigación 12 de Octubre (imas12) Ciber de Epidemiología y Salud Pública Cardiology Department Clínica Universitaria de Navarra Cardiology Department Hospital Valle Hebrón Cardiology Department Hospital Galdakano

AIM: To describe current profile of patients with cardio-vascular disease(CVD) and assessing changes through last ***: Comparison of patients with established CVD from two similar cross-sectional registries performed in 1999(n = 6194) and 2009(n = 4639).The types of CVD were coronary heart disease(CHD),heart failure(HF) and atrial fibrillation(AF).Patients were collected from outpatient *** were 80% cardiologist and 20% primary care *** antecedents,major diagnosis,blood test results and medical treatments were collected from all ***: An increase in all risk factors,except for smoking,was observed;a 54.4% relative increase in BP control was *** was the most prevalent CVD but HF and AF increased significantly,41.5% and 33.7%,respectively.A significant reduction in serum lipid levels was *** use of statins increased by 141.1% as did all cardiovascular ***,the use of angiotensin-renin system inhibitors in patients with HF,beta-blockers in CHD patients or oral anticoagulants in AF patients increased by 83.0%,80.3% and 156.0%,respectively(P revalence of all cardiovascular risk factors has increased in patients with CVD through last *** and AF have experienced the largest increases.

关键词： Cardiovascular disease Trends Heart failure Coronary heart disease Atrial fibrillation

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Effects of obstructive sleep apnea and its treatment over the erectile function： a systematic review

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Asian Journal of Andrology 2017年第3期19卷 303-310页

作者： Felix Campos-juanatey Marcos Fernandez-Barriales Monica gonzalez jose A Portillo-Martin Urology Department Marques de Valdecilla University Hospital Santander 39008 Spain Institute of Investigation Marques de Valdecilla Santander 39011 Spain Oral and Maxillofacial Surgery Department Araba University Hospital Araba 01004 Spain Sleep and Ventilation Unit Marques de Valdecilla University Hospital Santander 39008 Spain Medical and Surgical Sciences Department School of Medicine University of Cantabria Santander 39011 Spain.

Erectile dysfunction （ED） is considered a condition with a broad range of etiologies. Obstructive sleep apnea （OSA） syndrome is one of the lesser studied risk factors for ED. We intend to summarize the current evidence on the relationship between OSA and sexual impairment, focusing on the results in terms of erectile function of the different therapies offered to OSA patients. A systematic review was conducted, selecting articles related to the physiology of OSA and ED, and to the treatments of OSA syndrome and their reported outcomes in erectile and sexual function. Higher prevalences of ED in the OSA groups have been published. However, whether this effect on the erectile function occurs in the entire range of OSA severities remains unclear. Several hypotheses were proposed to explain the physiology of this association. Continuous Positive Airway Pressure as a treatment for OSA patients with ED has achieved a significative improvement in the sexual parameters in most of the studies. Phosphodiesterase type 5 inhibitors （iPDE5） on demand are useful as a treatment for ED in this subgroup of patients, with high satisfaction rates. The surgical treatment for the OSA evidenced benefits over the erectile function, and the effect on the sexual satisfaction of the therapy using Mandibular Advancement Devices is still undefined.

关键词： continuous positive airway pressure erectile dysfunction obstructive sleep apnea operative surgical procedures phosphodiesterase type 5 inhibitors

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renal function assessment in atrial fibrillation:Usefulness of chronic kidney disease epidemiology collaboration vs reexpressed 4 variable modification of diet in renal disease

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World Journal of Cardiology 2015年第10期7卷 685-694页

作者： rami riziq-Yousef Abumuaileq Emad Abu-Assi Andrea López-López Sergio raposeiras-roubin Moisés rodríguez-Manero Luis Martínez-Sande Francisco Javier García-Seara Xesus Alberte Fernandez-López jose ramón gonzález-juanatey Cardiology Department University Clinical Hospital of Santiago de Compostela

AIM: To compare the performance of the re-expressed Modification of Diet in renal Disease equation vs the new Chronic Kidney Disease Epidemiology Collaboration equation in patients with non-valvular atrial ***: We studied 911 consecutive patients with non-valvular atrial fibrillation on vitamin-K antagonist. The performance of the re-expressed Modification of Diet in renal Disease equation vs the new Chronic Kidney Disease Epidemiology Collaboration equation in patients with non-valvular atrial fibrillation with respect to either a composite endpoint of major bleeding, thromboembolic events and all-cause mortality or each individual component of the composite endpoint was assessed using continuous and categorical ≥ 60, 59-30, and r 1.73 m2 estimated glomerular filtration ***: During 10 ± 3 mo, the composite endpoint occurred in 98(10.8%) patients: 30 patients developed major bleeding, 18 had thromboembolic events, and 60 died. The new equation provided lower prevalence of renal dysfunction r 1.73 m2(32.9%),compared with the re-expressed equation(34.1%). Estimated glomerular filtration rate from both equations was independent predictor of composite endpoint(Hr = 0.98 and 0.97 for the re-expressed and the new equation, respectively; P rtality(Hr = 0.98 for both equations, P rong association with thromboembolic events was observed only when estimated glomerular filtration rate was r 1.73 m2: Hr is 5.1 for the re-expressed equation, and Hr = 5.0 for the new equation. No significant association with major bleeding was observed for both ***: The new equation reduced the prevalence of renal dysfunction. Both equations performed similarly in predicting major adverse outcomes.

关键词： Atrial fibrillation Anticoagulants Follow-up studies Kidney Prognosis

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Social media in cardiology:reasons to learn how to use it

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World Journal of Cardiology 2019年第10期11卷 217-220页

作者： rafael Vidal-Perez jose Juan Gómez de Diego Julia Grapsa ricardo Fontes-Carvalho jose ramon gonzalez-juanatey Heart Failure Unit Cardiology DepartmentHospital Clinico Universitario de SantiagoSantiago de Compostela 15706A CorunaSpain Centro de Investigación Biomédica en red de Enfermedades Cardiovasculares SpainSantiago de Compostela 15706A CorunaSpain Cardiovascular Institute Hospital Universitario San CarlosMadrid 28040Spain Cardiology Department St Bartholomew HospitalBarts Health TrustLondon EC1A 7BEUnited Kingdom Cardiology Department Centro Hospitalar GaiaUniversity of PortoPorto 4434-502Portugal

Social media has changed the way we learn,educate,and interact with our *** dynamic nature of social media and their immediate availability through our portable devices(smartphones,tablets,smartwatches,etc.)is quickly transforming the way we participate in *** scope of these digital tools is broad as they deal with many different aspects:Teaching and learning,case discussion,congresses coverage,peer to peer interaction,research are examples worth *** scientific societies considered more innovative,are promoting these tools between their *** new concepts need to be known by the cardiologists to stay updated,as countless information is moving rapidly through these *** summarize the main reasons why learning how to use these tools to be part of the conversation is essential for the cardiologist in training or fully stablished.

关键词： Social media Cardiology Congress Learning Teaching Interaction Cardiovascular diseases Impact Factor Portable devices Smartphone Tablet

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Myocardial infarction with non-obstructive coronary arteries: A comprehensive review and future research directions

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World Journal of Cardiology 2019年第12期11卷 305-315页

作者： rafael Vidal-Perez Charigan Abou Jokh Casas rosa Maria Agra-Bermejo Belén Alvarez-Alvarez Julia Grapsa ricardo Fontes-Carvalho Pedro rigueiro Veloso jose Maria Garcia Acuña jose ramon gonzalez-juanatey Cardiology Department Hospital Clinico Universitario de SantiagoSantiago de Compostela 15706Spain Centro de Investigación Biomédica en red de Enfermedades Cardiovasculares(CIBErCV) Santiago de Compostela 15706Spain Cardiology Department St Bartholomew HospitalBarts Health TrustLondon EC1A 7BEUnited Kingdom Cardiology Department Centro Hospitalar GaiaVila Nova Gaia 4434-502Portugal Faculty of Medicine University of Porto Porto 4200-319Portugal

Acute coronary syndromes constitute a variety of myocardial injury presentations that include a subset of patients presenting with myocardial infarction with non-obstructive coronary arteries(MINOCA).This acute coronary syndrome differs from type 1 myocardial infarction(MI)regarding patient characteristics,presentation,physiopathology,management,treatment,and ***-thirds of MINOCA subjects present ST-segment elevation;MINOCA patients are younger,are more often female and tend to have fewer cardiovascular risk ***,MINOCA is a working diagnosis,and defining the aetiologic mechanism is relevant because it affects patient care and *** the absence of relevant coronary artery disease,myocardial ischaemia might be triggered by an acute event in epicardial coronary arteries,coronary microcirculation,or *** causes of MINOCA include coronary plaque disruption,coronary dissection,and coronary *** MINOCA mechanisms involve microvascular coronary spasm,takotsubo syndrome(TTS),myocarditis,and coronary *** angiography with non-significant coronary stenosis and left ventriculography are first-line tests in the differential study of MINOCA *** diagnostic arsenal includes invasive and non-invasive *** history and echocardiography can help indicate vasospasm or thrombosis,if one finite coronary territory is affected,or specify TTS if apical ballooning is *** ultrasound,optical coherence tomography,and provocative testing are *** magnetic resonance is a cornerstone in myocarditis *** is not a benign diagnosis,and its polymorphic forms differ in *** care varies across centres,and future multi-centre clinical trials with standardized criteria may have a positive impact on defining optimal cardiovascular care for MINOCA patients.

关键词： Myocardial infarction Non-obstructive coronary Myocardial infarction with non-obstructive coronary arteries Management Prognosis

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P2Y12受体抑制剂联合质子泵抑制剂对急性冠脉综合征患者缺血事件影响的临床分析

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中华医学杂志 2016年第33期96卷 2611-2615页

作者：冯斯婷严妍范婧尧王晓郑文聂绍平 Sergio raposeiras-roubin Emad Abu-Assi jose P Simao Henriques Fabrizio D' Ascenzo Jorge Saucedo jose r Conzalez-juanatey Stephen B Wilton Wouter J Kikkert Ivan Nunez-Gil Albert Ariza-Sole Dimitrios Alexopoulos Christoph Liebetrau Tetsuma Kawaji Claudio Moretti Zenon Huczek Toshiharu Fujii Luis C Correia Masa-aki Kawashiri Sasko Kedev 首都医科大学附属北京安贞医院急诊危重症中心 100029 University Hospital Alvaro Cunqueiro Vigo Spain Academic Medical Center Amsterdam the Netherlands Dipartimento di Scienze Mediche Divisione di Cardiologia Citta della Salute e della Scienza Turin Italy North Shore University Hospital Chicago USA University Clinical Hospital of Santiago de Compostela Santiago de compostela Spain Libin Cardiovascular Institute of Alberta Calgary Canada San Carlos Hospital Madrid Spain Bellvitge University Hospital Barcelona Spain University Patras Hospital Athens Greece Kerckhoff Heart and Thorax Center Frankfurt Germany Graduate School of Medicine Kyoto University Kyoto Japan University Clinical Hospital Warsaw Poland Hospital Sao rafael Salvador Brazil Kanazawa University Graduate School of Medicine Kanazawa Japan University Clinic of Cardiology Skopje Macedonia

目的本研究旨在分析P2Y12受体抑制剂联合质子泵抑制剂（PPI）治疗对经皮冠状动脉介入（PCI）术后的急性冠脉综合征患者缺血事件的影响。方法基于国际多中心回顾性注册登记研究，纳入2003至2014年因急性冠脉综合征人院行PCI术的患者，分... 详细信息

目的本研究旨在分析P2Y12受体抑制剂联合质子泵抑制剂（PPI）治疗对经皮冠状动脉介入（PCI）术后的急性冠脉综合征患者缺血事件的影响。方法基于国际多中心回顾性注册登记研究，纳入2003至2014年因急性冠脉综合征人院行PCI术的患者，分为PPI组及非PPI组并随访1年，主要临床终点为全因死亡／再发心肌梗死的复合终点。根据P2Y12受体抑制剂种类，将入组患者分为氯吡格雷组及替格瑞洛组，并比较不同药物与PPI联用发生临床终点事件的风险。结果研究入选9429例患者，PPI组占54．8％，具有更多高危因素。Cox回归结果提示PPI组较非PPI组全因死亡／再发心肌梗死复合事件的发生差异无统计学意义（Hr1．00，95％CI 0．86—1．18）。根据P2Y12抑制剂种类不同分为氯吡格雷组和替格瑞洛组，不同P2Y12受体抑制剂联用PPI较未联用PPI患者的临床终点无差异，联用PPI的氯吡格雷组与替格瑞洛组的临床终点差异也无统计学意义。结论急性冠脉综合征患者PPI与P2Y12受体抑制剂联用不增加全因死亡和再发心肌梗死风险，尤其PPI联用氯吡格雷在患者的缺血事件上与替格瑞洛比较差异无统计学意义。

关键词：急性冠脉综合征氯吡格雷质子泵抑制剂患者结局评价替格瑞洛

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Impact of concomitant use of proton pump inhibitors and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome

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Journal of Geriatric Cardiology 2016年第3期13卷 209-217页

作者： Yan YAN Xiao WANG Jing-Yao FAN Shao-Ping NIE Sergio raposeiras-roubin Emad Abu-Assi jose P Simao Henriques Fabrizio D'Ascenzo Jorge Saucedo jose r gonzfilez-juanatey Stephen B Wilton Wouter J Kikkert Ivlin Nufiez-Gil Albert Ariza-Sole Xian-Tao SONG Dimitrios Alexopoulos Christoph Liebetrau Tetsuma Kawaji Claudio Moretti Zenon Huczek Toshiharu Fujii Luis C Correia Masa-aki Kawashiril Sasko Kedev Beijing Anzhen Hospital Capital Medical University Beijing China University Hospital.4lvaro Cunqueiro Vigo Spain University Academic Medical Center Amsterdam the Netherlands Dipartimento di Scienze Mediche Divisione di Cardiologia. Citt& della Salute e della Scienza Turin Italy NorthShore University Hospital Chicago. USA University Clinical Hospital of Santiago de Compostela Spain Libin Cardiovascular Institute of Alberta Calgary Canada San Carlos Hospital Madrid Spain Bellvitge Hospital Barcelona Spain University Patras Hospital Athens Greece Kerckhoff Heart and Thorax Center Frankfurt Germany Graduate School of Medicine Kyoto University Kyoto Japan University Clinical Hospital Warsaw Poland Tokai University School of Medicine Tokyo Japan Hospital Sao rafaeL Salvador Brazil Kanazawa University Graduate School of Medicine Kanazawa Japan University Clinic of Cardiology Skopje Macedonia

Background There is great debate on the possible adverse interaction between proton pump inhibitors （PPIs） and clopidogrel. In ad- dition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains less known. We aimed to determine the impact of concomi- tant administration of PPIs and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome （ACS） after percuta- neous coronary intervention （PCI）. Methods We retrospectively analyzed data fi＇om a ＂real world＂, international, multi-center registry between 2003 and 2014 （n = 15,401） and assessed the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year composite primary endpoint （all-cause death, re-infarction, or severe bleeding） in patients with ACS after PCI. results Of 9429 patients in the final cohort, 54.8% （n = 5165） was prescribed a PPI at discharge. Patients receiving a PPI were older, more often female, and were more likely to have comorbidities. No association was observed between PPI use and the primary endpoint for patients receiving clopidogrel （ad- justed Hr： 1.036; 95% CI： 0.903-1.189） or ticagrelor （adjusted Hr： 2.320; 95% CI： 0.875-45.151）（Pinteraction = 0.2004）. Similarly, use of a PPI was not associated with increased risk of all-cause death, re-infarction, or a decreased risk of severe bleeding for patients treated with either clopidogrel or ticagrelor. Conclusions In patients with ACS following PCI, concomitant use of PPIs was not associated with in- creased risk of adverse outcomes in patients receiving either clopidogrel or ticagrelor. Our findings indicate it is reasonable to use a PPI in combination with clopidogrel or ticagrelor, especially in patients with a higher risk of gastrointestinal bleeding.

关键词： Acute coronary syndrome Clopidogrel Outcome Proton pump inhibitor Ticagrelor

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Prognostic significance of heart rate in hospitalized patients presenting with myocardial infarction

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World Journal of Cardiology 2012年第1期4卷 15-19页

作者： Lorenzo Fácila Pedro Morillas Juan Quiles Federico Soria Alberto Cordero Pilar Mazón Manuel Anguita Cándido Martín-Luengo jose ramón gonzalez-juanatey Vicente Bertomeu Department of Cardiology Consorcio Hospitalario General de Valencia Department of Cardiology Hospital Universitario de San Juan Department of Cardiology Hospital Virgen de la Arrixaca Department of Cardiology Hospital Clínico Universitario Santiago de Compostela Department of Cardiology Hospital Reina Sofía Department of Cardiology Hospital Universitario de Salamanca

AIM: To investigate the prognostic significance of resting heart rate in patients with acute coronary syndrome (ACS), independent of other known factors. METHODS: Patients 40 years of age or older who had been admitted with acute coronary syndrome (ACS) to one of the 94 hospitals participating in the Prevalence of Peripheral Arterial Disease in Patients with Acute Coronary Syndrome (PAMISCA) study were included. Patients were divided into two groups based on their resting heart rate (Hr ≥ or re recording during a follow-up period of 1 year. rESULTS: There were 1054 ACS patients analyzed (43.5% with ST segment elevation and 56.5% without elevation). Mean age was 66.6 ± 11.7 years, 70.6% were male and 29.4% of subjects were female. During follow-up, more patients in the Hr ≥ 70 bpm group were hospitalized for heart failure and they also had a higher mortality rate. In the multivariate analysis, a heart rate of ≥ 70 bpm was independently related to overall mortality during the follow-up period (hazard ratio 2.5; 95% confidence interval, 1.26-4.97, P = 0.009). CONCLUSION: A resting heart rate ≥ 70 bpm in patients who survive an ACS is an indicator of a high risk of suffering cardiovascular events during follow-up.

关键词： Heart rate Myocardial infarction Prognosis

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联合应用氯吡格雷和质子泵抑制剂对急性冠状动脉综合征患者经皮冠状动脉介入术后预后的影响

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中国医药 2017年第2期12卷 161-166页

作者：严研王晓范婧尧聂绍平 Sergio raposeiras-roubin Emad Abu-Assi jose Paulo Simao Henriques Fabrizio D'Ascenzo Jorge Saucedo jose ramon gonzalez-juanatey Stephen B. Wilton Wouter J. Kikkert Ivan Nunez-Gil Albert Ariza-Sole Dimitrios Alexopoulos Christoph Liebetrau Testuma Kawaji Claudio Moretti Zenon Huczek Toshiharu Fujii Luis Claudio Correia Masa-aki Kawashiri Sasko Kedev 首都医科大学附属北京安贞医院急诊危重症中心 000029 西班牙比戈市阿尔瓦罗康克雷诺医院心内科 36312 荷兰阿姆斯特丹大学学术医学中心心内科 1105 意大利都灵市圣乔瓦尼巴蒂斯塔医院心内科 10126 美国芝加哥市北岸大学医院心内科 60201 西班牙圣地亚哥·德·孔波斯特拉大学临床医院心内科 15706 加拿大卡尔加里市阿尔伯塔利宾心血管研究所心脏科学医学科 T2N4N1 西班牙马德里市圣卡洛斯医院心内科 28040 西班牙巴塞罗纳市贝尔维尔医院心内科 08907 希腊雅典市佩特雷大学医院心内科 26504 德国法兰克福市基尔霍夫胸腔心脏中心心内科 61231 日本京都大学医学研究生院心内科 606-8507 波兰华沙市临床医院心内科 02-091 日本东京市东海大学医学院心内科 259-1193 巴西萨尔瓦多市圣拉斐尔医院 41253-190 日本金泽大学医学研究生院心内科 920-0942 马其顿斯科普里市临床心脏病诊所心内科 1000

目的探讨联合应用氯吡格雷和质子泵抑制剂（PPI）对急性冠状动脉综合征（ACS）患者经皮冠状动脉介入（PCI）术后预后的影响。方法回顾性分析2003年至2014年来自10个国家（加拿大，巴西，德国，波兰，荷兰，西班牙，意大利，希腊，中国... 详细信息

目的探讨联合应用氯吡格雷和质子泵抑制剂（PPI）对急性冠状动脉综合征（ACS）患者经皮冠状动脉介入（PCI）术后预后的影响。方法回顾性分析2003年至2014年来自10个国家（加拿大，巴西，德国，波兰，荷兰，西班牙，意大利，希腊，中国，日本）15个临床中心的ACS合并PCI术后18077例患者的临床资料。研究氯吡格雷、PPI与ACS患者PCI术后预后的关系。比较患者的基本临床特征、既往病史、生化指标、药物应用，以及终点事件的发生率情况。通过Cox回归模型进行分析及倾向性评分调整其他可能影响患者的预后因素包括人口学信息（年龄、性别）和临床指标，计算PPI这一干预因素的风险比并评价其是否能够明显影响患者的预后。结果基于国际多中心Blee MACs注册登记研究分析，排除关键数据缺失过多患者2676例。根据纳入与排除标准及倾向性评分调整整理后，再排除患者6461例，最终列队患者8940例。根据患者用药不同，将患者分为氯吡格雷＋PPI组（4814例）和氯吡格雷组（4126例）。氯吡格雷＋PPI组患者女性、高血压病史、高脂血症病史、糖尿病史、外周血管疾病史、既往急性心肌梗死史、慢性肾功能不全病史、消化道溃疡病史、冠状动脉旁路移植术病史、既往出血病史、恶性肿瘤病史、不稳定型心绞痛、非sT段抬高型心肌梗死、心功能Killip分级≥2级、经皮腔内冠状动脉成形术、出院后血管紧张素转换酶抑制剂／血管紧张素Ⅱ受体拮抗剂应用比例、年龄和入院时血肌酐水平明显高于氯吡格雷组[25．4％（1225／4814）比21．0％（865／4126）、59．9％（2882／4814）比49．2％（2032／4126）、48．3％（2327／4814）比42．7％（1762／4126）、26．4％（1272／4814）比22．1％（910／4126）、8．0％（386／4814）比5．6％（231／4126）、12．3％（593／4814）比10．6％（436／4126）、2．0％（98／4814）比0．7％（30／4126）、2．3％（112／4814）比1．0％（42／4126）、3．6％（172／4814）比2．2％（92／4126）、4．5％（219／4814）比3．0％（123／4126）、8．0％（387／4814）比4．7％（193／4126）、13．4％（644／4814）比9．1％（374／4126）、29．1％（1400／4814）比15．9％（656／4126）、14．5％（699／4814）比11．2％（462／4126）、56．0％（2697／4814）比55．7％（2300／4126）、75．5％（3633／4814）比68．6％（2829／4126）、（66±12）岁比（61±13）岁、（10±6）mg／L比（9±4）mg／L]；且入院时血红蛋白水平和出院后β受体阻滞剂应用比例明显低于氯吡格雷组[（138±19）g／L比（141±16）g／L、80．6％（3880／4814）比83．1％（3428／4126）]，差异均有统计学意义（均P〈0．05）。调整前，氯吡格雷＋PPI组主要终点事件（全因死亡／再发心肌梗死／出血）发生率明显高于氯吡格雷组，差异有统计学意义（风险比为1．331，95％置信区间为1．161-1．524）。调整后，氯吡格雷＋PPI组主要终点事件（全因死亡／再发心肌梗死／出血）发生率与氯吡格雷组比较，差异无统计学意义（风险比为1．036，95％置信区间为0．903-1．189）。结论ACS患者PCI术后联合应用PPI与氯吡格雷是合理的，尤其在胃肠道出血高危患者中。

关键词：急性冠状动脉综合征氯吡格雷质子泵抑制剂预后

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急性冠状动脉综合征患者经皮冠状动脉介入术后出血情况分析

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中国医药 2017年第6期12卷 801-805页

作者：严研王晓范婧尧聂绍平宋现涛 Sergio raposeiras-roubin Emad Abu-Assi jose Paulo Simao Henriques Fabrizio D'Ascenzo Jorge Saucedo jose ramon gonza1ez-juanatey Stephen B. Wilton Ivan Nufiez-Gil Albert Ariza-Sole Dimitrios Alexopoulos [ Christoph Liebetrau Testuma Kawaji Zenon Huczek Toshiharu Fujii Luis Claudio Correia Masa-aki Kawashiri Sasko Kedev 首都医科大学附属北京安贞医院急诊危重症中心 100029 首都医科大学附属北京安贞医院心内科 100029 西班牙比戈市阿尔瓦罗康克雷诺医院心内科 36312 荷兰阿姆斯特丹大学学术医学中心心内科 1105 意大利都灵市圣乔瓦尼巴蒂斯塔医院心内科 10126 美国芝加哥市北岸大学医院心内科 60201 西班牙圣地亚哥·德·孔波斯特拉大学临床医院心内科 15706 加拿大卡尔加里市阿尔伯塔省利宾心血管研究所心脏科学医学科 T2N4N1 西班牙马德里市圣卡洛斯医院心内科 28040 西班牙巴塞罗纳市贝尔维尔医院心内科 08907 希腊雅典市佩特雷大学医院心内科 26504 德国法兰克福市基尔霍夫胸腔心脏中心心内科 61231 日本京都大学医学研究生院心内科 606-8507 日本东京市东海大学医学院心内科 259-1193 巴西萨尔瓦多市圣拉斐尔医院心内科 41253-190 日本金泽大学医学研究生院心内科 920-0942 马其顿斯科普里市临床心脏病诊所心内科 1000

目的分析急性冠状动脉综合征（ACS）经皮冠状动脉介入（PCI）术后出血情况。方法回顾性分析2003年1月至2014年12月来自11个国家16个临床中心的18077例行PCI的ACS患者的临床资料。根据是否出现出血事件，将患者分为出血组（558例）和非... 详细信息

目的分析急性冠状动脉综合征（ACS）经皮冠状动脉介入（PCI）术后出血情况。方法回顾性分析2003年1月至2014年12月来自11个国家16个临床中心的18077例行PCI的ACS患者的临床资料。根据是否出现出血事件，将患者分为出血组（558例）和非出血组（17519例），比较2组患者的基本临床特征、手术情况及生化指标。分析ACS患者PCI术后出血相关情况。结果马其顿中心数据因关键变量缺失过多而被排除患者2676例，故最终纳入10个国家15个中心15401例ACS患者。排除缺失数据，本研究共有12910例患者收集到出血部位的数据，409例患者存在出血事件。胃肠道是最常见出血部位，占48．7％（199／409），颅内出血占7．6％（31／409）。Logistic逐步回归方法多因素分析显示，既往出血病史、高血压病史是术后1年内消化道出血的危险因素。排除马其顿中心数据（2676例）与Cox回归模型和倾向性评分调整再排除5972例，剩余9429例作分层分析。根据是否联用质子泵抑制剂（PPI），将出院应用氯吡格雷生存患者8942例分为氯吡格雷联合应用PPI组（4814例）和氯吡格雷未联合应用PPI组（4126例）；将出院应用替格瑞洛生存患者489例分为替格瑞洛联合应用PPI组（351例）和替格瑞洛未联合应用PPI组（138例）。Kaplan-Meier法分析显示氯吡格雷联合应用PPI组1年出血事件发生率明显高于氯吡格雷未联合应用PPI组，差异有统计学意义（P=0．004）；替格瑞洛联合应用PPI组1年出血事件发生率与替格瑞洛未联合应用PPI组比较，差异无统计学意义（P=0．573）。结论ACS患者PCI术后最常见的出血部位为消化道，PPI与替格瑞洛联合应用在胃肠道出血风险较高患者中适用。

关键词：急性冠状动脉综合征出血质子泵抑制剂氯吡格雷替格瑞洛

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