冠状动脉介入治疗后有无肝素方案对临床预后的影响

Effect of the strategy with or without heparin on clinical prognosis of patients after the procedure of coronary stenting

目的 探讨冠状动脉支架置入术后是否应用肝素对临床预后的影响。方法 回顾性分析了 1998- 10～ 2 0 0 1- 10所有冠状动脉支架术病人在鞘管拔出后用或不用静脉肝素方案对住院期间、30d缺血事件和出血并发症的影响。结果 肝素组住院期间缺血并发症低于无肝素组 ,缺血并发症减少 5 8% (3.70 %vs 9.10 % ,P <0 .0 0 5 ) ,QMI减少 75 % (0 .2 9%vs 1.2 0 % ,P <0 .0 2 5 ) ,NQMI减少 6 5 % (1.5 0 %vs4 .35 % ,P <0 .0 0 5 ) ,靶血管再PTCA减少 78% (0 .90 %vs 4 .10 % ,P <0 .0 0 5 ) ,30d靶血管再梗死率降低 75 % (0 .34%vs 1.4 0 % ,P <0 .0 1) ;两组间出血并发症未见明显区别 (6 .0 0 %vs 5 .10 % ,P >0 .2 5 ) ;进一步分析发现 ,隔夜肝素组和 3d肝素组缺血和出血并发症也无明显区别 (2 .0 0 %vs3.90 % ,P>0 .1和 5 .90 %vs7.2 0 % ,P>0 .5 )。结论 冠状动脉支架术后常规应用肝素能减少住院期间和 30dQMI、NQMI、靶血管再PTCA的发生率和亚急性血栓形成。延长静脉应用肝素不能进一步改善病人的缺血并发症 ,但也不增加出血可能性。

Objective To explore the effect of the strategy with or without intravenous heparin for the patients after the procedure of coronary stenting on clinical prognosis. Methods To analyze retrospectively all eligible patients with coronary stenting from Oct.1998 to Oct. 2001 and compare the differences between ischemic events and bleeding complications in the patients with or without intravenous heparin strategy after coronary stenting during hospital stay and in 30 days. Results The study included 2 400 cases with coronary stenting who were divided into two groups: heparin group (1 749 patients, 72.9% of all), average age was 62±11 years, male accounted for 65%; No heparin group (651 patients,27.1% of all), male accounted for 67%, average age was 63±12 years; The study found that the heparin group decreased all in-hospital ischemic events about 58%(3.7% vs 9.1%, P<0.005), QMI decreased 75%(0.29% vs 1.2%, P<0.025), NQMI decreased 65%(1.5% vs 4.3%, P<0.005), target vessel re-PTCA decreased 78%(0.9% vs 4.1%, P<0.005),30-day target vessel re-infarction decreased 75%(0.34% vs 1.40%, P<0.01) respectively. There was no bleeding complication difference between two groups(6.0% vs 5.1%, P>0.25). Further analysis showed that the subgroups of 3 days intravenous heparin and over-night intravenous heparin did not have any difference between ischemic events and bleeding complications (2.0% vs 3.9%, P>0.1 and 5.9% vs 7.1%, P>0.5). Conclusions Routine intravenous heparin after sheath removal can decrease in-hospital ischemic events (QMI, NQMI, target vessel re-PTCA) and decrease subacute thrombosis in 30 days. Prolonged intravenous heparin administration does not further improve these ischemic complications, but does not increase bleeding possibility.