比伐卢定在女性急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗中的抗凝效果及安全性

The anticoagulant efficacy and safety of Bivalirudin on primary percutaneous coronary intervention in female patients with acute ST-segment elevation myocardial infarction

目的评价女性急性ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉介入(PCI)治疗中应用比伐卢定抗凝疗效及安全性。方法收集2016年1月～2018年1月因STEMI就诊于北京市大兴区人民医院并行急诊PCI的女性患者共182例。根据术中使用抗凝药物情况分为比伐卢定组(94例)和普通肝素或联合替罗非班组(88例)。评价两组在住院期间及术后30 d内的主要不良心脑血管事件发生情况(MACCE),包括心源性死亡、非致死性心梗、再次血运重建、支架内血栓和缺血性卒中。评价住院期间和术后30 d内的出血事件。结果随访30 d,比伐卢定组和肝素组分别有2、5例患者发生MACCE事件,差异无统计学意义(P> 0.05)。两组住院期间出血发生率比较,差异无统计学意义(P> 0.05),但随访30 d肝素组出血发生率高于比伐卢定组,差异有统计学意义(P <0.05)。结论女性急性ST段抬高型心肌梗死患者行PCI时应用比伐卢定可以达到良好的抗凝效果,并且安全性更好。

Objective To evaluate anticoagulant efficacy and safety of Bivalirudin on primary percutaneous coronary intervention(PCI)in female patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of182female patients diagnosed with STEMI undergoing primary PCI in Beijing Daxing District People′s Hospital from January2016to January2018were selected.According to the using of anticoagulant drugs during primary PCI,they were divided into Bivalirudin group(94cases)and Heparin with or without Tirofiban group(88cases).Major adverse cardio cerebral vascular events(MACCE),including cardiac death,non-lethal myocardial infarction,revascularization,stent thrombosis,and ischemic stroke,during hospitalization and within30days after primary PCI were evaluated.Bleeding events during hospitalization and within30days after primary PCI were evaluated.Results After30days′follow-up,2patients occurred MACCE in the Bivalirudin group and5patients in the Heparin with or without Tirofiban group,there was no statistically significant difference(P>0.05).There was no statistically significant difference in bleeding events ratio between the two groups(P>0.05),but the incidence of hemorrhage during30days′follow-up in the Heparin with or without Tirofiban group was higher than that in the Bivalirudin group,and the difference was statistically significant(P<0.05).Conclusion To female patients with acute ST-segment elevation myocardial infarction,it can achieve the same anticoagulant effects with better safety by Bivalirudin when the patients are treated with PCI.