冠状动脉内注射比伐卢定对急性ST段抬高型心肌梗死接受直接冠状动脉介入治疗患者影响研究

Effect of bivalirudin on patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

目的探讨冠状动脉内注射比伐卢定对急性ST段抬高型心肌梗死接受直接冠状动脉介入治疗患者冠状动脉无复流预防作用的影响。方法选取北部战区总医院2017年3—8月收治的86例急性ST段抬高型心肌梗死接受直接冠状动脉介入治疗的患者为研究对象。根据随机编码信封进行分组,将患者分入A组(冠状动脉内注射生理盐水10.00 ml组,n=40)和B组(冠状动脉内注射比伐卢定0.75 mg/kg组,n=46)。记录并比较主要终点[靶血管矫正心肌梗死溶栓治疗(TIMI)帧数、术后90 min心电图ST段完全回落率]和次要终点[术后30 d内净临床不良事件(包括全因死亡、再次心肌梗死、靶血管血运重建、脑卒中、支架内血栓及出血学术研究联合会定义的出血事件)发生率]。结果纳入时,A、B组的靶血管矫正TIMI帧数分别为(78.43±36.62)、(85.10±31.16),差异无统计学意义(P>0.05);靶血管矫正TIMI帧数≥40的比例分别为72.5%(29/40)、82.6%(38/46),差异无统计学意义(P>0.05)。分组时,A、B组的靶血管矫正TIMI帧数分别为(31.43±16.62)、(27.10±15.16),差异无统计学意义(P>0.05);靶血管矫正TIMI帧数≥40的比例分别为30.0%(12/40)、34.8%(16/46),差异无统计学意义(P>0.05)。在冠状动脉支架置入后(包括支架后扩张全部完成)即刻复查冠状动脉造影,结果显示,A、B组的靶血管矫正TIMI帧数分别为(34.16±19.22)、(20.90±12.04),差异有统计学意义(P<0.05);靶血管矫正TIMI帧数≥40的比例分别为27.5%(11/40)、4.3%(2/46),差异有统计学意义(P<0.05)。术后,A、B组的靶血管矫正TIMI帧数分别为(24.16±22.62)、(17.95±7.17),差异无统计学意义(P>0.05);靶血管矫正TIMI帧数≥40的比例分别为7.5%(3/40)、2.2%(1/46),差异无统计学意义(P>0.05)。A、B组的术后90 min心电图ST段完全回落率分别为85.0%(34/40)、87.0%(40/46),差异无统计学意义(P>0.05)。A、B组的术后30 d内净临床不良事件发生率分别为12.5%(5/40)、6.5%(3/46),差异无统计学意义(P>0.05)。结论冠状动脉内注射比伐卢定对急性ST段抬高型心肌梗死接受直接冠状动脉介入治疗患者的冠状动脉无复流具有较好的预防作用,且安全性高。

Objective To investigate the effect of bivalirudin on the prevention of coronary artery no-reflow in patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Methods A retrospective study was performed on 86 cases of patients with STEMI who underwent PPCI from March to Agugust 2017.Patients were divided into the Group A(10.00 ml intravascular saline injection group,n=40)and Group B(0.75 mg/kg intravascular bivalirudin injection group,n=46)according to the random coding envelope.The primary end point[target vessels corrected the thrombolysis in myocardial infarction(TIMI)frame count,90 minutes postoperative ecg ST segment completely falling rate]and the secondary end point net[within 30 days postoperative clinical adverse events(including for all-cause death,myocardial infarction,target vessels reascularization,again,stent thrombosis and hemorrhage stroke association for the study of academic definition of bleeding events)incidence]were recorded and compared.Results At the time of inclusion,the TIMI frames of target vessel correction in Group A and Group B were(78.43±36.62)and(85.10±31.16),respectively,with no statistically significant difference(P>0.05).The proportion of TIMI frame number more than 40 was 72.5%(29/40)and 82.6%(38/46),respectively,and the difference was not statistically significant(P>0.05).At the time of grouping,the TIMI frames of target vessel correction in Group A and Group B were(31.43±16.62)and(27.10±15.16),respectively,and the difference was not statistically significant(P>0.05).The proportion of TIMI frame number more than 40 in target vessel correction was 30.0%(12/40)and 34.8%(16/46),respectively,with no statistically significant difference(P>0.05).Immediate review of coronary angiography after coronary stent implantation(including the completion of post-stent dilation)showed that the TIMI frames of target vessel correction in Group A and Group B were(34.16±19.22)and(20.90±12.04),respectively(P<0.05).The proportion of TIMI frames with more than 40 targets was 27.5%(11/40)and 4.3%(2/46),respectively(P<0.05).At the end of the surgery,the TIMI frames of target vessel correction in Group A and Group B were(24.16±22.62)and(17.95±7.17),respectively,and the difference was not statistically significant(P>0.05).The proportion of TIMI frames more than 40 was 7.5%(3/40)and 2.2%(1/46),respectively,with no significant difference(P>0.05).The complete regression rate of ST segment of ecg in Group A and Group B at 90 minutes after surgery was 85.0%(34/40)and 87.0%(40/46),respectively,with no statistically significant difference(P>0.05).The net incidence of clinical adverse events within 30 days after surgery in Groups A and B was 12.5%(5/40)and 6.5%(3/46),respectively,with no statistically significant difference(P>0.05).Conclusion Bivalirudin has a good preventive effect and high safety in patients with acute ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention with no-reflow.