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比伐芦定在老年冠状动脉慢性完全闭塞性病变患者中的应用研究

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摘要:

目的 探讨比伐芦定在接受经皮冠状动脉介入治疗(PCI)的老年冠状动脉(冠脉)慢性完
全闭塞(CTO)病变患者的疗效。方法 连续入选2016年1月至2018年1月于辽宁省人民医院就诊明确诊断
CTO病变的老年冠脉粥样硬化性心脏病(冠心病)患者118例。随机分为普通肝素(UFH)组(冠状动脉
造影前给予2500 U,PCI前补充100 U/kg,每过1 h追加1000 U;66例)和比伐芦定组(0.75 mg/kg负荷量,
续以1.75 mg/kg/h至术后4 h;52例)。主要有效性终点定义为住院期间及出院后6个月的主要心血管不良
事件(MACE)发生率。安全性终点是PCI后任何出血或者术区相关并发症。结果 比伐芦定组PCI后慢血
流/无复流发生率(3.8% vs. 16.7%,P=0.037)、小出血发生率(17.3% vs. 34.8%,P=0.039)均显著低于
UFH组。住院期间,比伐芦定组PCI相关心肌梗死发生率显著低于UFH组(9.6% vs. 25.8%,P=0.032);
出院后6个月时间内,两组MACE发生率比较无统计学差异(P均>0.05)。结论 老年冠脉CTO病变患者
PCI中使用比伐芦定抗凝治疗可降低无复流/慢血流和PCI相关急性心梗发生率,同时可降低术区出血相关
并发症,不增加6个月MACE风险。

Abstract:

 Objective To investigate the curative effect of bivalirudin in elderly patients with chronic total
occlusion of coronary artery (CTO) undergone percutaneous coronary intervention (PCI). Methods CTO patients
(n=118) were chosen from People’s Hospital of Liaoning Province from Jan. 2016 to Jan. 2018. All patients were
divided randomly into unfractionated heparin group (UFH group, given 2500 U of UFH before coronary angiography,
100 U/kg before PCI, 1000 U every 1 h, n=66), and bivalirudin group (given 0.75 mg/kg of bivalirudin, 1.75 mg/kg/h
continuously to 4 h after PCI, n=52). The main efficacy endpoint was defined as the incidence rate major adverse
cardiovascular events (MACE) during hospitalization period and after discharged for 6 months. The safety endpoint
was any bleeding and postoperative complications around PCI area. Results The incidence rates of slow flow/noreflow
(3.8% vs. 16.7%, P=0.037) and minor bleeding (17.3% vs. 34.8%, P=0.039) were significantly lower in
bivalirudin group than those in UFH group after PCI. During hospitalization period, the incidence rate of PCIrelated
myocardial infarction was significantly lower in bivalirudin group than that in UFH group (9.6% vs. 25.8%,
P=0.032). After discharged for 6 months, the incidence rate of MACE had no statistical difference between 2 groups
(all P>0.05). Conclusion Bivalirudine as an anticoagulant used during PCI can reduce the incidence rates of slow
flow/no-reflow, PCI-related myocardial infarction and bleeding-related complications around PCI area without
increasing the risk of MACE for 6 months in elderly patients with CTO.

基金项目:

2014年辽宁省省直医院改革重点临床科室诊疗能力建设项目(LNCCC-B02-2014)

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