Comparison Study On Clinical Of Domestic Bivalirudin And Heparin During Percutaneous Coronary Intervention Of Acute ST Elevated Myocardial Infarction

Background and objective:With the increasing morbidity of acute myocardial infarction (AMI), it threatens persons’health because of its high mortality and disability rate. So several researchers focus on reducing its mortality and improving its outcome. Several studies indicate that dredging the target vessel in early phase can reduce the infarction size, improve cardiac function,reduce the mortality,which is the most effective therapy of AMI.The development of PCI provided a better therapy to patients and made reperfusion treatment advance significantly. With application of anticoagulant drugs in PCI, MACE events and postoperative bleeding risk become the focus of recent research of anticoagulant drugs.This paper focus on the safety and efficacy of domestic bivalirudin during the PCI of STEMI.Method:The 124 cases are all patients of STEMI which are received PCI in the first hospital affiliated to Dalian medical university from June 2014 to December 2014.The diagnostic criteria of STEMI is based on the 2012 European Society of Cardiology. The cases are divided into two groups,including bivalirudin group(62 cases) and heparin group(62 cases), which is applied bivalirudin and heparin respectively. Bivalirudin is applied according to the recommend use:0.75mg/kg iv before PCI, then 1.75mg/kg continuously pumped, the remaining liquid pumped in 2 hours,0.175mg/kg continuously pumped for 12 hour in the patients with high thrombus load, heparin is not applied after PCI. Heparin use:100IU/kg iv, extra 1000IU (PCI time> lhour)(Tirofiban lOug/kg iv,0.15ug/(kg.min) pumped for 24-36 hours in the patients with high thrombus load), then lower molecular heparin subcutaneous injection per 4-6h. Estimate the bleeding events in perioperative period to compare the bleeding rate and MACE after PCI for 1 month according to the BARC bleeding criteria. Result:Test ACT of 23 patients in bivalirudin group 5min after the drug application,postoperation,drug withdrawal, the results are 502.33±114.97s 436.03±68.30s,361.71±102.64s.The bleeding rate is 6.45%,11.29% respectively of bivalirudin and heparin group, which is statistically insignificant.The rate of MACE after PCI for 1 month is 1.61%、3.23%, which is also statistically insignificant. Conclusion:l.The ACT of 5min after the drug application, postoperation,drug withdrawal are all more than 225s,which demonstrates that domestic bivalirudin is effective to prevent contact thrombus.2.The bleeding rate of two groups is statistically insignificant, however the lower bleeding rate of bivalirudin group still shows the safe superiority.3.There is no statistical difference of the MACE rate between two groups in hospital and 1 month after PCI, which demonstrate the anticoagulant effect of bivalirudin is almost the same with heparin and replace the heparin in emergency PCI of STEMI。...