比伐卢定对代谢综合征急性ST段抬高心肌梗死患者急诊经皮冠状动脉介入治疗的安全性
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摘要
目的观察比伐卢定对代谢综合征急性ST段抬高心肌梗死(STEMT)患者急诊经皮冠状动脉介入治疗(PCI)的安全性。方法纳入2016年7月至2017年7月代谢综合征STEMT患者92例,根据术中用药情况分为比伐卢定组和肝素组,其中比伐卢定组42例,肝素组50例。记录患者围手术期及术后1年出血事件及心血管不良事件。结果两组主要心血管不良事件发生率无统计学差异(P>0.05),比伐卢定组出血事件发生率低于肝素组(P <0.05)。结论对于代谢综合征STEMT患者应用比伐卢定具有良好的安全性,且与肝素相比具有较低的出血发生率。
Objective To observe Safety of bivalirudin in primary percutaneous coronary intervention(PCI) on patients with acute ST-segment elevation myocardial Infarction(STEMI) and metabolic syndrome.Methods From 2016/7 to 2017/7,a total of 92 patients with acute STEMI and metabolic syndrome treated by primary PCI in our hospital were retrospectively studied.The patients were divided in to two groups according to procedural bivalirudin application as bivalirudin group and heparin group. The baseline condition,coronary artery imaging condition,perioperative and 30-day post-operative occurrence of bleeding events and adverse cardiovascular events were compared between two groups. Results There was no significant difference in incidence of adverse cardiovascular events between two groups(P < 0.05),but the total number of cases with occurrence of bleeding events in the bivalirudin group were significant lower than the heparin group. Conclusion With advantage of lower incidence of bleeding and better safety,bivalirudin shows equivalent antithrombotic effect to heparin.
Objective To observe Safety of bivalirudin in primary percutaneous coronary intervention(PCI) on patients with acute ST-segment elevation myocardial Infarction(STEMI) and metabolic syndrome.Methods From 2016/7 to 2017/7,a total of 92 patients with acute STEMI and metabolic syndrome treated by primary PCI in our hospital were retrospectively studied.The patients were divided in to two groups according to procedural bivalirudin application as bivalirudin group and heparin group. The baseline condition,coronary artery imaging condition,perioperative and 30-day post-operative occurrence of bleeding events and adverse cardiovascular events were compared between two groups. Results There was no significant difference in incidence of adverse cardiovascular events between two groups(P < 0.05),but the total number of cases with occurrence of bleeding events in the bivalirudin group were significant lower than the heparin group. Conclusion With advantage of lower incidence of bleeding and better safety,bivalirudin shows equivalent antithrombotic effect to heparin.
引文
[1]IBANEZ B,JAMES S,AGEWALL S,et al.2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology(ESC)[J].Eur Heart J,2018,39(2):119-177.
[2]中华医学会心血管病学分会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[3]何小伍,马礼坤,黄文胜,等.血栓抽吸导管联合替罗非班治疗老年急性ST段抬高型心肌梗死的效果[J].中国老年学杂志,2017,37(2):368-370.
[4]张丽,丁世芳,蒋桔泉,等.经桡动脉入径直接经皮冠状动脉介入治疗术联合替罗非班治疗急性ST段抬高型心肌梗死的临床疗效研究[J].中国全科医学,2016,19(10):1156-1160.
[5]KAYMAZ C,KELES N,N?,et al.The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI[J].Anatol J Cardiol,2016,15(11):899-906.
[6]WARDROP D,KEELING D.The story of the discovery of heparin and warfarin[J].Br J Haematol,2010,141(6):757-763.
[7]翟原苑,马海平,郑宏,等.肝素与抗凝监测的研究进展[J].临床和实验医学杂志,2018,17(1):111-113.
[8]SCIULLI T M,MAURO V F.Pharmacology and clinical use of bivalirudin[J].Ann Pharmacother,2002,36(6):1028-1041.
[9]SHAMMAS N W.Bivalirudin:pharmacology and clinical applications[J].Cardiovasc Ther,2010,23(4):345-360.
[10]LINCOFF A M,BITTL J A,KLEIMAN N S,et al.The RE-PLACE 1 trial:a pilot study of bivalirudin versus heparin during percutaneous coronary intervention with stenting and GP IIb/IIIa blockade[J].J Am Coll Cardiol,2002,39(2):16-17.
[11]STONE G W,WITZENBICHLER B,GUAGLIUMI G,et al.Heparin plus a glycoprotein IIb/IIIa inhibitor versus bivalirudin monotherapy 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,2011,377(9784):2193-2204.
[12]LINCOFF A M,BITTL J A,HARRINGTON R A,et al.Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention:REPLACE-2 randomized trial[J].JAMA,2004,13(10):853-863.
[13]HAMON M,RASMUSSEN L H,MANOUKIAN S V,et al.Choice of arterial access site and outcomes in patients with acute coronary syndromes managed with an early invasive strategy:the ACUITY trial[J].Eurointervention,2009,5(1):115-120.
[2]中华医学会心血管病学分会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[3]何小伍,马礼坤,黄文胜,等.血栓抽吸导管联合替罗非班治疗老年急性ST段抬高型心肌梗死的效果[J].中国老年学杂志,2017,37(2):368-370.
[4]张丽,丁世芳,蒋桔泉,等.经桡动脉入径直接经皮冠状动脉介入治疗术联合替罗非班治疗急性ST段抬高型心肌梗死的临床疗效研究[J].中国全科医学,2016,19(10):1156-1160.
[5]KAYMAZ C,KELES N,N?,et al.The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI[J].Anatol J Cardiol,2016,15(11):899-906.
[6]WARDROP D,KEELING D.The story of the discovery of heparin and warfarin[J].Br J Haematol,2010,141(6):757-763.
[7]翟原苑,马海平,郑宏,等.肝素与抗凝监测的研究进展[J].临床和实验医学杂志,2018,17(1):111-113.
[8]SCIULLI T M,MAURO V F.Pharmacology and clinical use of bivalirudin[J].Ann Pharmacother,2002,36(6):1028-1041.
[9]SHAMMAS N W.Bivalirudin:pharmacology and clinical applications[J].Cardiovasc Ther,2010,23(4):345-360.
[10]LINCOFF A M,BITTL J A,KLEIMAN N S,et al.The RE-PLACE 1 trial:a pilot study of bivalirudin versus heparin during percutaneous coronary intervention with stenting and GP IIb/IIIa blockade[J].J Am Coll Cardiol,2002,39(2):16-17.
[11]STONE G W,WITZENBICHLER B,GUAGLIUMI G,et al.Heparin plus a glycoprotein IIb/IIIa inhibitor versus bivalirudin monotherapy 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,2011,377(9784):2193-2204.
[12]LINCOFF A M,BITTL J A,HARRINGTON R A,et al.Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention:REPLACE-2 randomized trial[J].JAMA,2004,13(10):853-863.
[13]HAMON M,RASMUSSEN L H,MANOUKIAN S V,et al.Choice of arterial access site and outcomes in patients with acute coronary syndromes managed with an early invasive strategy:the ACUITY trial[J].Eurointervention,2009,5(1):115-120.