Objective To investigate the incidence,clinical characteristics and risk factors of upper gastrointestinal bleeding (UGIB) in patients with acute coronary syndrome (ACS) who were administrated with aspirin and clopidogrel dual antiplatelet therapy after percutaneous coronary intervention (PCI).Methods ACS patients who had undergone PCI in the cardiovascular institute of Guangdong General Hospital from September 2009 to August 2014 were retrospectively enrolled.The incidence of UGIB and clinical characteristics of ACS patients on dual antiplatelet therapy for 1 year after PCI were analyzed.Risk factors of UGIB were screened in the cohort of patients and sex and age matched controls with ratio 1:3.Results A total of 9 118 ACS patients had undergone PCI and UGIB occurred in 189 patients (2.07％,189/9 118) from September 2009 to August 2014.UGIB patients with history over one year,gastrointestinal tumors or varices or negative endoscopy were excluded.Thus the revised incidence of UGIB occurred was 0.61％ in 56 patients (0.61％,56/9 118) and appeared to decline year by year.Most patients (91.07％,51/56) had melena or stool occult blood positive (OB +),while others had bloody stool or haematemesis.Most UGIB were ulcer-related which was proved by endoscopy,accounting for 67.86％(38/56).There were 24 cases with duodenal ulcer,13 with gastric ulcer and 1 with complex ulcer,while others were gastric erosion,gastritis and duodenitis.The risk factors of UGIB were previous history of peptic ulcer (P ＜ 0.01) and renal impairment (P ＜ 0.01).On the other side,PPI intake was a protective factor (P ＜ 0.05).The incidence of new-onset ACS was 1.44％ (50/3 464) in PPI group,compared with 1.34％(76/5 654) in no PPI group (P ＞ 0.05).PPI use for the prevention of UGIB after PCI didn't increase the recurrence of ACS.Conclusions The incidence of UGIB is 0.61％ in ACS patients on dual antiplatelet therapy (aspirin and clopidogrel) for 1 year after PCI and falls year by year.Administration of PPI after PCI protects patients from UGIB,especially in those with precious history of peptic ulcer and renal impairment.

Objective To explore statin dosages for targeting goal of LDL-C lowering on the basis of stroke risk stratification and the dosage-effective relation of statin and LDL-C lowering in Chinese patients with ischemic stroke and transient ischemic attack (TIA).Methods This is a prospective and open clinical trial patients with ischemic stroke/TIA within 6 months were enrolled and the dosages of atorvastatin were calculated based on risk stratification according to "Chinese Consensus for Prevention of Ischemic Stroke/TIA with Statin" (Chinese Consensus).A dose of 10 mg of atorvastatin daily to target LDL-C goal was takenas the standard dosage targeting goal (SDTG).Patients taking this dosage of atorvastatin constituted a SDTG group.Those who needed a daily dose of 20 mg or more of atorvastatin were randomized into an intensive dosage targeting goal (IDTG) group ( atorvastatin 20-80 mg/d) and a standard dosage non-targeting goal (SDNTG) group (atorvastatin 10 mg/d without targeting goal).All patients took atorvastatin for 12 weeks.The primary outcome was the rate of targeting goal for LDL-C lowering at 2,4 and 12 weeks,respectively and the secondary outcome was the occurence of recurrent stroke and other vascular events within 12 weeks.The main safety endpoint was serial adverse events including symptomatic intracranial hemorrhage.Results Altogether 102 cases were enrolled and 99 cases were followed up for 12 weeks.According to the Chinese Consensus,the rate of high risk,very high risk- Ⅰ and very high risk- Ⅱ was 44% ,28% and 28%,respectively.Targeting rate for LDL-C lowering was 77% -85% at each time point in the SDTG and IDTG groups ,being significantly higher than those in the SDNTG group ( 12% -16%,P < 0.01 ).No significant difference was found concerning the occurrence of recurrent stroke,other vascular events and safety endpoints among the three groups.The amplitude of LDL-C lowering was 32%-35% ,46%-49% ,51%-52% and 60%-65% with corresponding to daily dosage of 10 mg,20 mg,d0 mg and 80 mg atorvastatin.Conclusions At least more than half of the patients after iscbemic stroke/TIA need intensive statin therapy to target the LDL-C lowering goal.The dosage- effective relation of atorvastatin and LDL-C lowering in Chinese is similar to the reported data in other races.