摘要
Background It.s an effective treatment to implement percutaneous coronary intervention in acute myocardial infarction patients,which rapidly achieve coronary reperfusion. However,many patients with no-reflow,leading to cardiovascular events,even sudden death. Bivalirudin has been used in anticoagulant therapy in PCI,which was characterized by rapid onset,strong anticoagulant effect and good safety. The HORIZONS-AMI study showed that bivalirudin reduced the risk of bleeding and death after PCI compared with heparin and glycoprotein IIb/IIIa antagonists. However,bivalirudin increased the risk of acute stent rethrombosis compared to unfractionated heparin and glycoprotein Ⅱb/Ⅲa antagonists. Therefore,the use of bivalirudin in emergency PCI was worth exploring. EUROMAX trial prompted that the patients who underwent emergency PCI and received intravenous use of bivalirudin during transit,might reduce the risk of bleeding. But there were few studies about bivalirudin on the effects of coronary reperfusion. This study was designed to investigate the effects of bivalirudin on coronary blood flow in patients with AMI and the safety of the drug. Methods All 120 AMI patients were divided into treatment group(n=60)and control group(n=60)according to random number method 1:1. In the treatment group,after coronary angiography and before PCI,the intravenous injection of bivalirudin(0.75mg/kg)was proportional,and then the intravenous maintenance was continued(1.75 mg·kg-1·h-1)for 5 h. In the control group,after coronary angiography and before PCI,intravenous injection of tirofiban(10 μg/kg)and unfractionated heparin(100 U/kg),followed by continuous intravenous injection of tirofiban(0.75 μg·kg-1·min-1)for 24 h. The TIMI blood flow classification,corrected TIMI frame number,TIMI myocardial perfusion grade(TMPG),Cardiac ultrasound parameters,serum NT-ProBNP and hs-CRP were recorded in the two groups before and after PCI. Major cardiovascular events(MACE),bleeding event,etc. were recorded. Results The ratio of coronary blood flow TIMI3 and TMPG3 after coronary intervention were significantly higher in treatment group than in control group(P<0.05);TIMI frame number showed that the coronary blood flow of treatment group was significantly faster than the control group(P<0.05). The LVEF value of the treatment group was higher than the control group after 30 d(P<0.05). Postoperative serum NT-ProBNP and hs-CRP in the treatment group were significantly lower than those in the control group(P<0.05). Conclusion Compared to tirofiban with heparin,using bivalirudin during acute PCI in AMI patients significantly improved coronary blood flow,reduced inflammatory response,reduced the incidence of MACE and bleeding,and improved the short-term prognosis.
Background It.s an effective treatment to implement percutaneous coronary intervention in acute myocardial infarction patients,which rapidly achieve coronary reperfusion. However,many patients with no-reflow,leading to cardiovascular events,even sudden death. Bivalirudin has been used in anticoagulant therapy in PCI,which was characterized by rapid onset,strong anticoagulant effect and good safety. The HORIZONS-AMI study showed that bivalirudin reduced the risk of bleeding and death after PCI compared with heparin and glycoprotein IIb/IIIa antagonists. However,bivalirudin increased the risk of acute stent rethrombosis compared to unfractionated heparin and glycoprotein Ⅱb/Ⅲa antagonists. Therefore,the use of bivalirudin in emergency PCI was worth exploring. EUROMAX trial prompted that the patients who underwent emergency PCI and received intravenous use of bivalirudin during transit,might reduce the risk of bleeding. But there were few studies about bivalirudin on the effects of coronary reperfusion. This study was designed to investigate the effects of bivalirudin on coronary blood flow in patients with AMI and the safety of the drug. Methods All 120 AMI patients were divided into treatment group(n=60)and control group(n=60)according to random number method 1:1. In the treatment group,after coronary angiography and before PCI,the intravenous injection of bivalirudin(0.75mg/kg)was proportional,and then the intravenous maintenance was continued(1.75 mg·kg-1·h-1)for 5 h. In the control group,after coronary angiography and before PCI,intravenous injection of tirofiban(10 μg/kg)and unfractionated heparin(100 U/kg),followed by continuous intravenous injection of tirofiban(0.75 μg·kg-1·min-1)for 24 h. The TIMI blood flow classification,corrected TIMI frame number,TIMI myocardial perfusion grade(TMPG),Cardiac ultrasound parameters,serum NT-ProBNP and hs-CRP were recorded in the two groups before and after PCI. Major cardiovascular events(MACE),bleeding event,etc. were recorded. Results The ratio of coronary blood flow TIMI3 and TMPG3 after coronary intervention were significantly higher in treatment group than in control group(P<0.05);TIMI frame number showed that the coronary blood flow of treatment group was significantly faster than the control group(P<0.05). The LVEF value of the treatment group was higher than the control group after 30 d(P<0.05). Postoperative serum NT-ProBNP and hs-CRP in the treatment group were significantly lower than those in the control group(P<0.05). Conclusion Compared to tirofiban with heparin,using bivalirudin during acute PCI in AMI patients significantly improved coronary blood flow,reduced inflammatory response,reduced the incidence of MACE and bleeding,and improved the short-term prognosis.
作者
孙学玉
张玉英
韩增雷
SUN Xue-yu;ZHANG Yu-ying;HAN Zeng-lei
基金
supported by Qingdao Municipal Health Commission Planning Project(No.2015-WJZD066)
