不同风险等级STEMI患者急诊PCI应用比伐卢定与肝素+替罗非班的疗效与安全性比较  

Efficacy and safety of bivalirudin versus heparin plus tirofiban in emergency PCI in different risk level patients of STEMI

作　　者：马威[1] 黄琨[1] 孙淑娴[1] 张宇[1] 贾风顺 郑川燕 王兆祥[1] 李昌义[1] 亢小丽[1] 吴峥 纪征[1] 

机构地区：[1]唐山市工人医院心内科,河北唐山063000 [2]首都医科大学附属北京安贞医院北京市心肺血管疾病研究所心内科

出　　处：《临床心血管病杂志》2017年第12期1180-1185,共6页Journal of Clinical Cardiology

基　　金：2017年度医学科学研究重点课题计划项目(No:20171366);唐山市科技指令科学技术研究与发展项目(No:12150222B-15);国家自然科学基金(No:81070227)

摘　　要：目的:比较不同风险等级ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入术(PCI)应用比伐卢定与肝素+替罗非班的疗效与安全性。方法:回顾性分析2015-01-2017-05收治的206例急诊PCI患者病历资料,据入院STEMI TIMI危险评分分为低中危组(117例)和高危组(89例),每组又据抗凝方案分为比伐卢定亚组和肝素+替罗非班亚组,比较不同风险等级相同抗凝方案、同风险等级内不同抗凝方案术后血流灌注、超声心动图改变、临床安全性。结果:不同风险等级患者相同抗凝方案亚组间患者支架成功植入率(比伐卢定:96.2%∶97.6%;肝素+替罗非班:96.9%∶95.7%)、术后梗死相关动脉(IRA)TIMI 3级血流获得率(比伐卢定:82.0%∶78.0%;肝素+替罗非班:79.4%∶77.3%)、术后MBG 3级获得率(比伐卢定:74.0%∶70.7%;肝素+替罗非班:73.0%∶68.2%)差异均无统计学意义(P>0.05);同风险等级不同抗凝方案亚组间支架成功植入率、术后IRA TIMI 3级血流获得率及MBG 3级获得率差异亦无统计学意义(P>0.05)。不同风险等级相同抗凝方案亚组术后48h左室射血分数(LVEF)、峰射血率(PER)、A峰E峰流速比(E/A)变化幅度绝对值差异均无统计学意义(P>0.05);同风险等级不同抗凝方案亚组术后LVEF、PER、E/A变化幅度绝对值差异亦无统计学意义(P>0.05)。高危组中肝素+替罗非班亚组出血发生率显著高于低中危组(20.5%∶4.9%,P<0.05),不同风险等级同种抗凝方案亚组术中无复流、术后血小板减少症、支架内狭窄、再发心肌梗死及死亡发生率差异均无统计学意义(P>0.05)。低中危组住院期间主要不良心血管事件(MACE)发生率均低于高危组(比伐卢定:2.0%∶9.8%;肝素+替罗非:3.2%∶13.6%;P>0.05);高危组应用比伐卢定住院期间MACE发生率略低于肝素+替罗非班(9.8%∶13.6%,P>0.05)。结论:低中危风险STEMI患者急诊PCI应用比伐卢定或肝素+替罗非班住院期间出血、MACE发生率低于高Objective：To compare the efficacy and safety of bivalirudin versus heparin plus tirofiban in emergency PCI in different risk level patients of STEMI.Method：A retrospective analysis was conducted on 206 PCI patients from January 2015 to May 2017,which were divided into mild middle risk group（117 cases）and high risk group（89 cases）according to STEMI thrombolysis in myocardial infarction trial（TIMI）risk score.Patients in each group were further divided into Bivalirudin subgroup and heparin plus tirofiban group according to different anticoagulation scheme.The indexes on postoperative blood perfusion,echocardiography and clinical safety of the same anticoagulation in different TIMI risk levels and the different anticoagulation regimens within the same TIMI risk level were collected and compared.Result：Patients with the same regimen in different risk groups were no significant differences in successful stent implantation ratio（bivalirudin：96.2% vs.97.6%;heparin ＋tirofiban：96.9% vs.95.7%）,IRA grade 3 TIMI blood flow ratio（bivalirudin：82.0%vs.78.0%;heparin＋tirofiban：79.4%,vs.77.3%）and grade 3 myocardial blush ratio after operation（bivalirudin：74.0% vs.70.7%;heparin＋ tirofiban：73.0% vs.68.2%）（P〈0.05）.Patients with different anticoagulation regimens in the same risk group had no statistical differences in successful stent implantation ratio,TIMI 3 blood flow ratio and MB 3 ratio（P〈0.05）.Patients with the same anticoagulation regimen in different risk groups had no significant differences on absolute variations of LVEF,PER,E/A 48 h after PCI（P〈0.05）.Patients with the different anticoagulation regimens in the same risk group had no significant differences in absolute variations of LVEF,PER,E/A either（P〈0.05）.Bleeding incidence with Heparin ＋ tirofiban regimen in high risk group was significantly higher than that in the mild middle risk group（20.5% vs.4.9%）（P〈0.05）.No significant differences were seen in no blood reflow,thrombocytopenia,stent

关 键 词：ST段抬高型心肌梗死 比伐卢定 心肌梗死溶栓实验危险评分 心肌灌注 主要不良心血管事件 

分 类 号：R542.2[医药卫生—心血管疾病]