Efficacy And Safety Of Different Doses Of Bivalirudin In Elderly Patients With STEMI Undergoing Direct PCI

Background: The main mechanism of ST elevation myocardial infarction(STEMI)is coronary atherosclerotic plaque rupture or endothelial erosion with occlusive thrombosis.The key to treatment and improvement of prognosis is as soon as possible.Open the infarction related artery(IRA)and restore the blood flow and function of the coronary microcirculation as soon as possible.The preferred reperfusion measure for patients with acute STEMI who can significantly improve prognosis and reduce mortality is primary percutaneous coronary intervention(PPCI).PPCI is currently the best reperfusion method for acute STEMI.Common perioperative bleeding is associated with anticoagulant drugs during or after coronary revascularization.For older patients with high risk of bleeding,assess the risk of bleeding and It is important to choose low-risk anticoagulant drugs,and the best intraoperative anticoagulant drugs to assist them are still controversial.OBJECTIVE: To compare the efficacy and safety of high-dose bivalirudin,low-dose bivalirudin,and unfractionated heparin in the treatment of elderly patients with acute STEMI(age≥70 years)with PPCI,and to improve the efficacy of clinical treatment of STEMI Provide a scientific basis for improving prognosis.METHODS: A prospective randomized controlled trial was conducted to select emergency STEMI for acute STEMI aged ≥70 years from February 2018 to February 2019 in the Loudi Central Hospital,which was eligible for inclusion,and intraoperative application of bivalirudin or 165 patients with heparin anticoagulation(15 patients were lost to follow-up),after obtaining written consent for PPCI,all patients were given aspirin 300 mg chew,100mg/day for life maintenance;clopidogrel 300 mg orally,postoperative 75mg/day Maintain at least one year.The 165 elderly patients with acute coronary syndrome were divided into three groups: group A(high-dose bivalirudin group,n=56 cases),group B(low-dose bivalirudin group,n=52 cases),group C(normal heparin group(control group),n = 57 cases).After PCI,the efficacy and safety evaluation were followed up for 30 days.The main indicators evaluated included net all-cause adverse events including all-cause death,emergency target vessel revascularization,recurrent myocardial infarction,stroke,and all hemorrhage.Events,NACE);secondary indicators include major cause of death,emergency target vessel revascularization,recurrent myocardial infarction,major adverse cardiac or cerebral events(MACCE);other observed indicators are It meets all bleeding,stent thrombosis,and thrombocytopenia as defined by the bleeding academic reaearch consortium(BARC).A statistical analysis of the safety and treatment outcomes of each group was compared to analyze whether there is a difference.Result: 1.The incidence of net clinical adverse events(NACE)in the bivalirudin group was lower than that in the heparin group(14.3% in the bivalirudin group,34.6% in the heparin group,P<0.05).2.There was no significant difference in the incidence of major adverse cardiovascular and cerebrovascular events(MACCE)between the high-dose bivalirudin group,the low-dose bivalirudin group,and the heparin group(high-dose bivalirudin group 4.0% vs.The low-dose bivalirudin group was 2.1% vs.heparin group 7.7%,P>0.05).3.The incidence of hemorrhagic events in the bivalirudin group was lower than that in the heparin group(10.2% in the bivalirudin group,26.9% in the heparin group,P<0.05),and there was a significant difference.The difference was statistically significant.4.The incidence of hemorrhagic events in the high-dose bivalirudin group was not significantly different from that in the low-dose bivalirudin group(10.0% in the high-dose bivalirudin group and 10.4% in the low-dose bivalirudin group,P>0.05),the difference was not statistically significant.5.The incidence of major bleeding events in the high-dose bivalirudin group was higher than that in the low-dose bivaliruding group(8.0% in the high-dose bivalirudin group vs 0.0% in the low-dose bivalirudin group,P<0.05),the difference was statistically significant.Conclusion 1.Acute ST elevation myocardial infarction in the elderly(age≥70 years)PPCI surgery with high dose of bivalirudin or low dose of bivaliruding treatment and the application of heparin treatment effect is not significantly different.2.Bivalirudin is more effective than heparin in reducing the incidence of bleeding after emergency PCI in elderly STEMI patients,and it is safe.3.Compared with the high-dose bivalirudin anticoagulation in elderly patients with acute ST-lifting myocardial infarction(age≥70 years),the incidence of recent major bleeding events in low-dose bivalirudin is relatively low.However,the overall incidence of bleeding events cannot be reduced.