替格瑞洛联合比伐芦定对急性ST段抬高型心肌梗死患者急诊PCI术中无复流/慢血流的作用

Effect of Ticagrelor Combined with Bivalirudin for no-Reflow/slow-Reflow in ST Segment Eevation Myocardial Infarction Patients Undergoing Emergency PCI

目的观察替格瑞洛联合比伐芦定在急性ST段抬高型心肌梗死(STEMI)患者行急诊PCI术中无复流/慢血流的发生情况,探讨其是否有预防作用。方法回顾性分析从2015年1月1日至2016年11月30日在我院行急诊PCI的STEMI患者,按照所使用的负荷抗血小板药物及术中抗凝药物分为:A组(氯吡格雷+肝素)、B组(氯吡格雷+比伐芦定)、C组(替格瑞洛+肝素)和D组(替格瑞洛+比伐芦定),观察术中球囊扩张后或支架植入后的血流再灌注情况,TIMI血流≤2级即为无复流/慢血流。结果 D组无复流/慢血流的发生率为16.51%,明显低于其余3组(P<0.01)。结论替格瑞洛联合比伐芦定能降低STEMI患者急诊PCI术中无复流/慢血流的发生率,两者或许具有协同作用。

Objective To study whether ticagrelor combined with bivalirudin can prevent the no- reflow/slow-reflow in patients with ST segment elevation myocardial infarction （STEMI）and receiving emergency PCI. Methods STEMI patients received emergency PCI from January l ,2015 to November 30, 2016 in our hospital were analyzedy retrospectively. The patients were divided into 4 groups according to the usage of antiplatelet drugs and anticoagulant drugs：Group A（ Clopidogrel ＋ Heparin） ,Group B（ Clopidogrel ＋ Bivalirudin）, Group C （ Tieagrelor ＋ Heparin ）, Group D （ Ticagrelor ＋ Bivalirudin ）, the reperfusion flow was observed after balloon dilation or stenting ,if TIMI flow ≤2, it was defined as no-reflow/slow-reflow. Results The incidence of no- reflow/slow- reflow in Group D is 16.51% ,which was significantly lower than that of other 3 groups （P 〈 0. 01 ）. Conclusion Ticagrelor combined with bivalirudin can reduce the incidence of no- reflow/slow-reflow in STEMI patients undergoing emergency PCI,they may have synergistic effect.