合并肾功能不全急性心肌梗死患者急诊经皮冠状动脉介入治疗中应用比伐芦定与肝素有效性与安全性分析

Evaluating the safety and effectiveness of Bivalirudin and Heparin in acute myocardial infarction patients complicated with renal insufficiencyreceiving primary percutaneous coronary intervention

目的探讨合并肾功能不全的急性心肌梗死(AMI)患者在急诊经皮冠状动脉介入治疗(PPCI)中应用比伐芦定和肝素的有效性和安全性。方法选取北部战区总医院自2016年3月至2019年3月收治的329例接受PPCI的AMI患者为研究对象。根据术中应用抗凝药物不同,将患者分入肝素组(n=191)和比伐芦定组(n=138)。主要终点事件为患者术后12个月的主要心脑血管不良事件,包含全因死亡、心肌梗死、缺血性卒中、靶血管血运重建(TVR)。次要终点事件为患者术后12个月的出血学术研究联合会2~5型和3~5型出血、全因死亡、心性死亡、心肌梗死、缺血性卒中及TVR。结果两组患者终点事件发生率比较,差异均无统计学意义(P>0.05)。结论对于接受PPCI的合并肾功能不全的AMI患者,应用比伐芦定和肝素进行抗凝治疗具有相似的临床预后。

Objective Toevaluate the safety and effectiveness of Bivalirudin and Heparin in acute myocardial infarction(AMI)patients complicated with renal insufficiency receiving primary percutaneous coronary intervention(PPCI).Methods A total of 329 patients with AMI who received PPCI from March 2016 to March 2019 were selected.According to the intraoperative application of anticoagulants, patients were divided into Bivalirudin group(n=138)and Heparin group(n=191).The primary endpoint was 12-month major adverse cardiovascular and cerebrovascular events(MACCE),includingall-cause mortality, myocardial infarction, ischemic stroke, target vessel revascularization(TVR).The primary secondary endpoints werebleeding academic research consortium(BARC)2-5,BARC 3-5,all-cause mortality, cardiac death, myocardial infarction, ischemic stroke and TVR.Results There was no significant difference in the incidence of endpoints between the two groups(P>0.05)Conclusion Bivalirudin and Heparin have similar clinical outcomes in AMI patients complicated with renal insufficiency receivingPPCI.