比伐芦定在老年ST段抬高型心肌梗死患者中应用的有效性和安全性

Efficacy and safety of bivalirudin in elderly patients with ST-segment elevation myocardial infarction

目的探讨老年急性ST段抬高型心肌梗死(STEMI)患者直接PCI围术期应用比伐芦定与普通肝素的有效性和安全性。方法连续入选吉林大学第一医院心内科行直接PCI的老年急性STEMI患者423例,按照围术期抗凝药物使用不同分为比伐芦定组187例和普通肝素组236例。分析2组基线资料、手术特点和住院期间并发症。主要终点:住院期间主要不良心脑血管事件(MACCE);次要终点:净临床不良事件。其他观察指标包括支架内血栓、获得性血小板减少症,出血学术研究会(BARC)1~2级出血和BARC全部出血事件。结果比伐芦定组住院期间MACCE和全因死亡较普通肝素组明显降低(3.7%vs9.7%,P=0.021;3.7%vs8.9%,P=0.039)。单因素logistic回归分析显示,在Killip分级Ⅰ级和肌酐清除率≥60ml/min的患者中,围术期比伐芦定组院内全因病死率较普通肝素显著降低(P<0.05)。结论老年急性STEMI患者直接PCI围术期应用比伐芦定可降低住院期间MACCE和全因病死率,尤其适用于Killip分级Ⅰ级和肌酐清除率≥60ml/min的患者。

Objective To investigate the efficacy and safety of bivalirudin versus unfractionated heparin during perioperative primary percutaneous coronary intervention(PCI)in elderly patients.with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 423 elderly patients with acute STEMI who underwent primary PCI in our hospital were consecutively enrolled in this study.According to different perioperative anticoagulant regimens,they were divided into bivalirudin group(187 cases)and unfractionated heparin group(236 cases).Baseline data,characteristics of interventional procedures and com plications during hospitalization were and-lyzed.Primary endpoint was major adverse cardiac or cerebral events(MACCE).Secondary end-points were net adverse clinical events.Other observational indicators included stent throm bosis,acquired thrombocytopenia,BARC types 1-2 bleeding and total bleeding events.Results Inhospital MACCE and allcause mortality were significantly lower in the bivalirudin group than unfractionated heparin group(3.7%vs 9.7%,P=0.021;3.7%vs 8.9%,P=0.039).Univariate logistic regression analysis showed that perioperative application of bivalirudin significantly reduced all-cause mortality in the patients with Killip grade Ⅰ and creatinine clearance≥60 ml/min when compared with unfractionated heparin(P<0.05).Conclusion In elderly patients with acute STEMI,perioperative use of bivalirudin significantly reduces the incidences of MACCE and all-cause death during hospitalization,especially in the patients with Killip grade Ⅰ and creatinine:clearance≥60 ml/min.