激活凝血酶时间对冠脉介入治疗术中血栓事件及住院期临床不良事件影响:单中心回顾性研究

Effect of activated clotting time on intra procedural thrombotic events during percutaneous coronary intervention and in-hospital major adverse cardiovascular events:a single-center retrospective study

目的探讨激活凝血酶时间(ACT)对冠脉介入治疗术中血栓事件(IPTE)以及住院期临床不良事件的影响作用。方法回顾性检索北部战区总医院心血管内科数据库2018年1—6月因冠心病住院治疗并接受冠脉介入治疗(PCI)的3578例患者的临床资料,PCI术中进行ACT监测共1979例,符合纳入标准共1410例。所有入选患者均按照PCI操作常规进行操作,记录患者给予标准剂量抗凝药物5 min后测定的首次ACT。依据首次ACT的数值分为ACT<225 s组(n=179)和ACT≥225 s组(n=1231),并记录PCI术中IPTE发生情况、住院期出血及主要不良心脑血管事件(MACCE)。结果两组患者一般资料比较,差异均无统计学意义(P>0.05);ACT<225 s组PCI术中发生IPTE的风险高于ACT≥225 s组,差异有统计学意义(6.1%比3.1%,P<0.05);IPTE事件中,ACT<225 s组冠脉内新发血栓的发生风险高于ACT≥225 s组(2.8%比0.3%,P<0.05),而两组间无复流或慢血流、冠脉突然再次闭塞以及远段血管栓塞事件的差异无统计学意义(P>0.05)。两组在MACE以及临床出血事件方面的差异均无统计学意义(P>0.05)。结论单中心回顾性分析结果提示,PCI术中首次ACT<225 s可能增加患者术中IPTE(冠脉内新发血栓)的发生风险。

Objective To investigate the effect of activated clotting time(ACT)on intra procedural thrombotic events(IPTE)during percutaneous coronary intervention(PCI)and in-hospital adverse.Methods A retrospective study was performed on 3578 cases of patients with coronary heart disease who were admitted and underwent PCI from January 2018 to June 2018.ACT monitoring during PCI was performed in a total of 1979 cases,and 1410 cases met the inclusion criteria.All the involved patients were operated according to PCI operation routine,and the first ACT measured 5 minutes after the standard dose of anticoagulant was recorded.According to the first ACT value,the patients were divided into ACT<225 s group(n=179)and ACT≥225 s group(n=1231),and the incidence of IPTE during PCI,in-hospital bleeding and main adverse cardiovascular and cerebrovascular events(MACCE)were recorded.Results There was no statistically significant difference in general data between the two groups(P>0.05).The risk of IPTE during PCI in ACT<225 s group was higher than that in ACT≥225 s group,and the difference was statistically significant(6.1%versus 3.1%,P<0.05).For IPTE,the risk of new coronary thrombosis in ACT<225 s group was higher than that in ACT≥225 s group(2.8%versus 0.3%,P<0.05),while there was no statistically significant difference between the two groups in terms of reflow or slow blood flow,sudden occlusion again of the coronary arteries,or distal vascular embolism events(P>0.05).There were no statistically significant differences in MACCE or clinical bleeding events between the two groups(P>0.05).Conclusion The results of single-center retrospective analysis suggests that ACT<225 s for the first time during PCI may increase the risk of intraoperative IPTE(new intracoronary thrombosis)in patients.