| Objective: To study the efficacy and safety of direct thrombin inhibitor bivalirudin in coronary intervention and predictors of adverse events after coronary intervention in the real world.Methods: A retrospective study was conducted on 706 patients with coronary heart disease treated with bivalirudin in Tianjin Chest Hospital from May 2016 to October 2017.Clinical data were collected from patients undergoing primary PCI and selective PCI.The incidence of stent thrombosis and net clinical adverse events,including allcause death,myocardial infarction,stroke,urgent target vessel revascularization and bleeding,were followed up for 30 days and 1 year.Logistic regression was used to analyze independent predictors of bleeding events within 30 days.COX regression was used to analyze independent predictors of MACCE events in patients with stent implantation within one year.Results: 1.A total of 706 patients were enrolled in this study,with an average age of(70.1± 11.1)years.The proportion of primary PCI patients was 39.1%(276/706),and that of elective PCI patients was 57.8%(408/706).Male patients accounted for 59.8%(422/706),moderate to severe renal insufficiency patients with e GFR < 60 ml/min accounted for 39.4%(278/706),anemia patients accounted for 32.3%(228/706),and The CRUSADE score >30 points in patients with moderate-high risk of bleeding accounted for 64%(452/706).2.The incidence of net adverse clinical events within 30 days was 4.2%(30/706),the incidence of major adverse cardiovascular and cerebrovascular events was 2.3%(16/706),the incidence of bleeding events was 2.3%(16/706),and the incidence of stent thrombosis was 0%.3.The incidence of net adverse clinical events within 1 year was 6.5%(46/706),major adverse cardiovascular and cerebrovascular events was 3.4%(24/706),bleeding events was 3.1%(22/706),and stent thrombosis was 0.8%(6/706).4.The incidence of bleeding within 30 days was 2.3% in all patients.Logistic regression analysis showed that women(OR: 8.954,95% CI: 1.885-42.528,P = 0.006),anemia(OR: 4.746,95% CI: 1.407-16.000,P = 0.012)were independent risk factors for bleeding events.5.Among 682 patients with stent implantation,the incidence of MACCE events was 5.3%.COX regression analysis showed BMI > 25kg/m2(OR:3.332,95%CI:1.201-9.246,P=0.021),KILLIP≥2(OR:2.147,95%CI:1.067-4.320,P=0.032),anemia(OR:2.074,95%CI: 1.009-4.265,P=0.047),EF value<45%(OR: 4.043,95%CI: 1.789-9.136,P=0.001),e GFR<60ml/min(OR:6.795,95%CI: 2.345-19.686,P<0.001)were independent risk factors for MACCE events.Statins(OR:0.106,95%CI: 0.049-0.230,P<0.001),PPI(OR: 0.421,95%CI: 0.194-0.914,P=0.029)were independent protective factors for MACCE events.Conclusion: 1.In this study,bivalirudin is mostly used in patients with more bleeding risk factors,and it has good anticoagulant effect and lower bleeding risk.2.Female and anemia were independent predictors of bleeding events within 30 days after PCI in patients treated with bivalirudin.3.BMI>25kg/m2,anemia,KILLIP ≥ 2,EF value<45%,e GFR<60ml/min were independent risk factors for MACCE events in patients treated with bivalirudin during perioperative period of PCI.Statins and PPI are independent protective factors for MACCE events. |
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