比伐卢定在急性ST段抬高型心肌梗死患者溶栓后介入治疗中的疗效与安全性研究

Efficacy and safety of bivalirudin in percutaneous coronary intervention after fibrinolysis for acute myocardial infraction

目的：探讨急性ST段抬高型心肌梗死（STEMI）患者溶栓后行经皮冠状动脉介入治疗（PCI）中应用比伐卢定的有效性及安全性。方法112例外院已行溶栓治疗的急性STEMI患者通过胸痛中心网络转入我院后拟早期行PCI治疗，随机分为比伐卢定组（51例）及普通肝素组（61例），比较两组患者PCI术后冠状动脉TIMI血流，观察两组患者住院期间主要心脑血管不良事件（MACCE）及出血发生率。结果两组患者PCI术后TIMI血流比较差异无统计学意义（P＞0.05），比伐卢定组患者住院期间出血发生率与普通肝素组比较差异无统计学意义（P＞0.05），比伐卢定组住院期间MACCE发生率低于普通肝素组（3.9%vs.16.4%，P＝0.03）。结论在急性STEMI患者溶栓后PCI中应用比伐卢定，与普通肝素出血发生率相当，而心脑血管事件发生率显著降低。

Objective To evaluate the efficacy and safety of Bivalirudin（BIV）in patients with acute ST-segment elevation myocardial infarction（STEMI）undergoing percutaneous coronary intervention（PCI）after thrombolysis. Methods A total of 112 patients suffered from acute STEMI received PCI after thrombolytics were randomly divided into 2 groups,of whom 51 patients received BIV during PCI procedure and 61 patients received unfractionated heparin（UFH）during PCI procedure. The thrombolysis in myocardial infarction （TIMI） flow grade before and after PCI was assessed between two groups. The incidence of the major adverse cardiac and cerebrovascular events（MACCE）and bleeding during hospitalization were compared between the two groups. Results There were no differences in TIMI flow grade before and after PCI. The major bleeding rate in BIV group during hospitalization was similar with the patients treated with UFH,while the incidence of MACCE was lower in the BIV group （3.9% vs. 16.4%,P=0.03）. Conclusion Bivalirudin and heparin had the same bleeding rate intreating the STEMI patients after thrombolytic therapy who subsequently underwent PCI,while bivalirudin was associated with less MACCE compared with UFH.