非ST段抬高型急性冠脉综合征患者经皮冠状动脉介入治疗中延时应用比伐芦定效果评价

Prolonged bivalirudin infusion for NSTE-ACS after percutaneous coronary intervention

目的探讨在非ST段抬高型急性冠脉综合征(NSTE-ACS)人群中,经皮冠状动脉介入(PCI)术后延时应用比伐芦定的安全性和有效性。方法选取2016年1月至2017年1月在煤炭总医院心内科住院的NSTE-ACS患者中行冠状动脉造影且符合PCI条件者105例,分为普通肝素组44例(A组),比伐芦定常规组33例(B组)和比伐芦定延时组28例(C组)。出院后进行1次随访(PCI术后30 d),记录出血事件、急性支架内血栓和主要心血管不良事件(MACE)。结果 3组患者年龄、GRACE评分高危患者比较,差异均有统计学意义(P<0.01)。3组间冠脉病变支数比较,差异有统计学意义(P<0.05),其中,B组冠脉造影三支病变比例明显高于A组(P<0.05)。3组间术后总出血事件比较,差异有统计学意义(P<0.05),A组总出血事件发生率显著高于B组和C组(P<0.05)。3组间术后2~5型出血事件及3~5型出血事件发生率比较,差异无统计学意义(P>0.05)。术后30 d随访,A组有2例MACE事件,包括1例消化道大出血死亡和1例非致死性急性心肌梗死;B组有1例急性支架内血栓形成经抢救成功存活;C组无MACE事件。A组发生1例PCI术后血小板减少。3组间MACE事件、血小板减少症、急性支架内血栓发生率比较,差异无统计学意义(P>0.05)。3组患者术后均多点检测激活全血凝固时间(ACT),术后即刻、停药后30 min及2 h的ACT数值比较,差异均有统计学意义(P<0.05)。结论对于NSTE-ACS人群中,PCI术后延时应用比伐芦定是安全、有效。

Objective To evaluate the safety and efficacy of prolonged bivalirudin infusion for NSTE-ACS patients after percutaneous coronary intervention（PCI）.Methods A retrospective study was performed on 105 cases of patients with NSTE-ACS who were admitted and performed PCI from January 2016 to January 2017.Patients were divided into the unfractionated heparin group（Group A,n =44）,routine use of bivalirudin group（Group B,n = 33） and prolonged bivalirudin group（Group C,n = 28）.The bleeding events,MACE and acute in-stent thrombosis events were observed and recorded during hospitalization and first follow-up in 30 days after PCI.Results There were statistically significant differences among the three groups in age,GRACE score of high-risk patients rates（P〈0.01） and the number of coronary artery lesions in the three groups（P〈0.05）,the rate of triple branch lesions in Group B was significantly higher than that of Group A（P〈0.05）.The rate of total bleeding events in Group A was significantly higher than that of Group B and Group C（P〈0.05）.There were no significant differences among the three groups in the rates of 2 to 5 type bleeding and 3 to5 type bleeding（P〈0.05）.During follow-up in 30 days,there were 2 cases of MACE in Group A,including 1 case of death of massive digestive tract hemorrhage and 1 case of non-fatal acute myocardial infarction;there was 1 case with acute in-stent thrombosis in Group B,and there was no case of MACE in Group C.There was 1 case of PCI postoperative thrombocytopenia in Group A.There were no significant differences in the rates of MACE,thrombocytopenia and acute in-stent thrombosis among the three groups（P〈0.05）.There were statistically significant differences in the values of ACT immediately after PCI,30 minutes and 2 hours after PCI and drug withdrawal among the three groups（P〈0.05）.Conclusion It is safe and effective to prolong bivalirudin infusion for NSTE-ACS patients after PCI.