Статья
Факторы риска кровотечений у больных с острым коронарным синдромом: данные наблюдательного исследования ОРАКУЛ II
Цель. Выявление факторов риска кровотечений 2-5 типов по шкале BARC у больных, перенесших острый коронарный синдром (ОКС).Материал и методы. Использованы данные 1502 больных из наблюдательного открытого многоцентрового исследования, ОРАКУЛ II (ОбостРение ишемической болезни сердцА: логиКо-вероятностные пУти прогнозирования течения для оптимизации Лечения) — 894 мужчин (59,5%) и 608 женщин (40,5%), возраст — 65,7±12,9 лет. 560 (37,3%) имели ОКС с подъемом сегмента ST и 942 (62,7%) — ОКС без подъема ST. Кровотечения зарегистрированы у 164 больных (10,9%), в том числе во время индексной госпитализации — у 39 (2,6%), из них тяжелых (типы 3-5) 0,5%, значимых — 1,7% (типы 2-5).Результаты. В течение года после выписки кровотечения отмечены у 126 (8,4%) больных, больших — 0,8%, значимых — 2,4%. Развитие кровотечений 2-5 типа ассоциировалось с наличием язвенной болезни желудка и двенадцатиперстной кишки, желудочно-кишечным кровотечением в анамнезе, снижением клиренса креатинина, гемоглобина, возрастом больных, применением антикоагулянтов в составе тройной или двойной антитромботической терапии, проведением чрескожных коронарных вмешательств при индексной госпитализации и наличием сердечной недостаточности 2-4 класса по Killip при поступлении. ROC-анализ показал, что прогностическая ценность шкалы риска кровотечений ОРАКУЛ составляет 0,762, чувствительность — 62%, специфичность — 78%.Заключение. Таким образом, нами на материале рутинной клинической практики создана простая шкала оценки риска кровотечений у больных ОКС.
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