急性冠心症病人合併腸胃道出血之相關因子與存活率

Risk factors of gastrointestinal bleeding and survival in acute coronary syndrome patients

目的：急性冠心症（acute coronary syndrome;ACS）包括急性ST段上升心肌梗塞、非ST段上升心肌梗塞、不穩定心絞痛等三種類型，根據實證醫學研究結果，抗凝血劑及抗血小板治療能夠顯著降低急性冠心症病人的死亡和併發症的發生率，但同時也可能導致腸胃道出血（Gastrointestinal bleeding）之併發症，本研究為針對急性冠心症病人的臨床資料進行分析，研究其發生腸胃道出血之危險因素及分析其對預後影響。方法：藉由此一回顧性研究，我們將分析在加護病房中急性冠心症病人發生腸胃道出血的臨床特點及其危險因素，與其對臨床預後之影響。結果：本研究共收入213例符合急性冠心症收案條件（男性159例、女性54例），其中有36位病人發生腸胃道出血（男性28例、女性8例），平均年齡78.7±12.9歲，急性冠心症病人發生腸胃道出血發生率為17%。根據此臨床研究，我們清楚的發現腸胃道出血之高危險群包括：年齡大於75歲之老年患者（72%發生腸胃道出血），或在住院期間發生心因性休克、心臟衰竭、呼吸衰竭、腎衰竭、敗血症等併發症時。多變項分析顯示，大於75歲、呼吸衰竭以及敗血症為預測急性冠心症病人腸胃道出血的獨立危險因子。此外，發生腸胃道出血會明顯增加急性冠心症病人之總死亡率與心血管相關死亡率。結論：根據此臨床研究結果可以清楚發現急性冠心症患者發生腸胃道出血之高風險族群，同時了解其對病患預後之影響。因此考慮預防性地給予腸胃道出血之預防用藥，或適當減少抗凝血劑之使用，可能可以減少急性冠心症病人發生腸胃道出血機率。本研究對於台灣臨床上治療急性冠心症患者將有非常重要之參考價值。

Purpose: Acute coronary syndrome (ACS) refers to a group conditions that include ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA). ACS can place the patient in critical condition, necessitating diagnostic coronary angiography and often percutaneous or surgical coronary intervention to reduce complications or chances of death. ACS may also cause gastrointestinal (GI) bleeding, which is associated with poorer long-term outcomes in ACS patients. The aim of this study is to examine the risk factors for the occurrence of GI bleeding and analyze its prognosis on the outcomes of ACS patients. Methods: The study enrolled a total of 213 ACS patients (75% male).Thirty-six patients, with an average age 79±13, experienced GI bleeding (77% male). Clinical, laboratory data, medications and major cardiovascular events including total and cardiovascular deaths were recorded. Results: ACS patients that experienced GI bleeding were older (72% of patients ＞ 75 y/o experienced GI bleeding), experienced cardiogenic shock, heart failure, respiratory failure, renal failure and sepsis. Multivariate analysis disclosed that respiratory failure and sepsis were independent risk factors for predicting GI bleeding in ACS patients greater than 75 years of age. In addition, ACS patients that experienced GI bleeding had significantly increased total and cardiovascular mortality rate (p＜0.05, respectively). Conclusion: Aging, cardiogenic shock, heart failure, respiratory failure, renal failure and sepsis were risk factors for GI bleeding in ACS patients. Moreover, ACS patients with GI bleeding were shown to have a higher total and cardiovascular death rate than patients without GI bleeding.