比伐卢定在STEMI患者直接PCI治疗中有效性及安全性的研究

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摘要目的观察比伐卢定在急性ST段抬高型心肌梗死（STEMI）患者急诊PCI治疗中的疗效和安全性。方法随机选择2014年8月～2015年2月在我院急诊行PCI术的80例STEMI患者，随机分为观察组和对照组，各40例。观察组在PCI期间应用比伐卢定抗凝治疗，对照组应用普通肝素治疗。观察两组的梗死相关动脉PCI术后即刻TIMI血流、TMPG分级，比较两组的心电图ST段回落、左室射血分数值、左室舒张末期内径及住院期间的主要心血管事件及出血和血小板减少发生率。结果两组的TIMI血流分级、TMPG分级比较，差异均无统计学意义（P＞0.05）；观察组的心电图ST段回落、30 d左室射血分数值、左室舒张末期内径优于对照组，差异有统计学意义（P＜0.05）。观察组的牙龈出血及血尿发生率高于对照组，差异有统计学意义（P＜0.05）。两组30 d因心力衰竭再发心绞痛的住院率、不良反应发生率比较，差异均无统计学意义（P＞0.05）。结论在STEMI患者急诊PCI治疗中应用比伐卢定具有较好的临床效果和安全性，比伐卢定可作为STEMI患者急诊PCI的常规抗凝治疗措施。

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关键词 ：比伐卢定, 急性ST段抬高心肌梗死, 急诊PCI

Abstract：ObjectveTo observe the efficacy and safety of Bivalirudin therapy in STEMI patients undergoing emergency PCI.Methods80 STEMI patients with emergency PCI from August 2014 to February 2015 in our hospital were randomly selected and randomly divided into the observation group and the control group,40 cases in each groups.The observation group was treated by Bivalirudin therapy during the period of PCI,and the control group was treated with unfractionated Heparin(UFH).TIMI flow grade and myocardial perfusion grade(TMPG)were observed in the two groups post PCI.ST-segment of ECG,LVEF,left ventricular and diastolic diameter(LVEDD),the incidence of major adverse cardiac event(MACE),bleeding and the incidence of thrombocytopenia were compared between the two groups.ResultsThere was no statistically significant difference in the TIMI flow grade or TMPG between the two groups(P＞0.05).The ST-segment of ECG,the level of LVEF and LVEDD in 30 days after PCI in the observation group was better than that in the control group,with significant difference(P＜0.05).The incidence of gingival bleeding and hematuria in the observation group was higher than that in the control group,with significant difference(P＜0.05).There was no significant difference between the two groups of 30 d in the hospitalization rate of recurrent angina pectoris because of heart failure and adverse reaction rate between the two groups(P＞0.05).ConclusionIn STEMI patients with emergency PCI,application of Bivalirudin is safe and effect.Bivalirudin can be used in emergency PCI in patients with STEMI conventional anticoagulant treatment measures.

Key words： Bivalirudin ST-elevation acute myocardial infarction Emergency percutaneous coronary intervention

基金资助:辽宁省大连市卫生局重点支持项目；
北京力生心血管健康基金会领航基金项目（LHJJ20142511）

通讯作者: 邓根群（1966-），男，河北邢台人，硕士，主任医师，主要从事冠心病介入治疗研究，获省级科技进步奖1项，市级1项，主持局级在研课题1项，领航基金1项

作者简介: 张慧（1983-），女，辽宁大连人，硕士，主治医师，研究方向：冠心病介入治疗；郑晓群（1965-），辽宁辽阳人，博士，主任医师，心内科主任，主要从事冠心病介入治疗研究

引用本文:

张慧；邓根群；郑晓群. 比伐卢定在STEMI患者直接PCI治疗中有效性及安全性的研究[J]. 中国当代医药, 2017, 24(21): 65-68.
ZHANG Hui；DENG Gen-qun；ZHENG Xiao-qun. Efficacy and safety study of Bivalirudin therapy in STEMI patients undergoing emergency PCI. 中国当代医药, 2017, 24(21): 65-68.

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[1]	Patrick T，Frederick GK，Deborah D，et al.2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction[J].Circulation，2013，127（2）：362-425.
[2]	Stephan W，Philippe K，Fernando A，et al.2014 ESC/EACTS guidelines on myocardial revascularization[J].Rev Esp Cardiol（Engl Ed），2015，68（2）：144-156.
[3]	Coppens M，Eikelboom JW，Gustafsson D，et al.Translational success stories：development of direct thrombin inhibitors[J].Circ Res，2012，14（7）：920-929.
[4]	Shah A，Feldmen DN.Outcome of the HORIZONS-AMI trail：bivalirudin enhances long-term survival in patients with ST-elevation myocardial infarction undergoing angioplasty[J].Vasc Health Risk Manag，2012，10（8）：115-123.
[5]	Mehran R，Alexandra JL，Witzenbichler B，et al.Bivalirudin in patients undergoing primary angioplasty for acute myocardial infarction（HORIZONS-AMI）：1-year results of a randomised controlled trial[J].Lancet，2009，10（3）：1149-1159.
[6]	Stone GW，Witzenbichler B，Guagliumi G，et al.Heparin plus a glycoproteinⅡb/Ⅲa inhibitor versus bivalirudin monother-apy and paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction（HORIZONS-AMI）：final 3-year results from a multicentre，randomised controlled trial[J].Lancet，2011，6（84）：2193-2204.
[7]	Shahzad A，Kemp I，Mars C，et al.Unfractionated heparin versus bivalirudin in primary percutaneous coronary interven tion（HEAT-PPCI）：an open-label，single centre，randomised controlled trial[J].Lancet，2014，11（57）：1849-1858.
[8]	Steg PG，Huber K，Andreotti F，et al.Bleeding in acute coro nary syndromes and percutaneous coronary interventions：po sition paper by the Working Group on Thrombosis of the European Society of Cardiology[J].Eur Heart J，2011，8（15）：1854-1864.
[9]	Tamez H，Pinto DS，Kirtane AJ，et al.Effect of short procedural duration with bivalirudin on increased risk of acute stent thrombosis in patients with STEMI：a secondary analysis of the HORIZONS-AMI randomized clinical trial[J].JAMA Cardiol，2017，3（1）：101-108.
[10]	Schoos MM，De Luca G，Dangas GD.Impact of time to treatmand ent on the effects of bivalirudin vs.glycoproteinⅡb/Ⅲa inhibitors heparin in patients undergoing primary percutaneouscoronaryintervention：insightsfrom the HORIZONS-AMI trial[J].Euro Interv，2016，12（9）：1144-1153.
[11]	Wang H，Li Y，Cong H，et al.Efficiency and safety of bivalirudin in patients undergoing emergency percutaneous coronary intervention via radial access：a subgroup analysis from the bivalirudin in acute myocardial infarction versus heparin and GPI plus heparin trial[J].Catheter Cardiovasc Interv，2016，9（28）：268-274.
[12]	Ducrocq G，Steg PG，Van't Hof A，et al.Utility of post-procedural anticoagulation after primary PCI for STEMI：insights from a pooled analysis of the HORIZONS-AMI and EUROMAX trial[J].Eur Heart J Acute Cardiovasc Care，2016，6（10）：187-198.
[13]	Giustino G，Mehran R，Bansilal S，et al.Safety and efficacy of bivalirudin in patients with diabetes mellitus undergoing percutaneous coronary intervention：from the REPLACE-2，ACUITY and HORIZONS-AMI Trials[J].Am J Cardiol.2016，118（1）：6-16.
[14]	Dangas GD，Schoos MM，Steg PG，et al.Early stent thrombosis and mortality after primary percutaneous coronary intervention in ST-segment-elevation myocardial infarction：a patient-level analysis of 2 randomized trials[J].Circ Cardiovasc Interv，2016，9（5）：276-289.
[15]	Ng VG，Baumbach A，Grinfeld L，et al.Impact of bleeding and Bivalirudin therapy on mortality risk in women undergoing percutaneous coronary intervention（from the REPLACE-2，bleed acuity，and horizons-AMI trials[J].Am J Cardiol，2016，117（2）：186-191.
[16]	Yu J，Mehran R，Clayton T，et al.Prediction of 1-year mortality and impact of bivalirudin therapy according to level of baseline risk：a patient-level pooled analysis from three randomized trials[J].Catheter Cardiovasc Interv，2016，87（3）：391-400.
[17]	Han YL，Guo JC，Zheng Y，et al.Bilivarudin vs.heparin with or without tirofiban during primary percutaneous coronary intervention in acute myocardial infarction.The BRIGHT randomized clinical trail[J].JAMA，2015，313（13）：1336-1346.
[18]	Liang Z，Li Y，Wang J，et al.The safety and effectiveness of Bivalirudin in female patients with acute myocardial infarction undergoing primary angioplasty：a subgroup analysis of the BRIGHT trial[J].Catheter Cardiovasc Interv，2016，3（87）：608-615.