| 【objective】 To compare the efficacy and safety between bivalirudin and single heparin and tirofiban combining heparin in acute myocardial infarction patients who received percutaneous coronary intervention(PCI).【method】 Opt-in Yan’an University Affiliated Hospital of admitted during the April 2013 to April 2014 in 90 cases diagnosed with acute myocardial infarction(AMI)within 12 hours after onset(or 12-24 hours of the onset of chest pain remains discomfort or persistent ST-segment elevation or new left bundle branch block were made),non-ST-segment elevation myocardial infarction(NSTEMI) within 72 hours of the onset of those who complete the PCI. The average age of 54.49 ± 6.54(44-70) years, of which57 cases were male patients, female patients 33 cases. ALL 90 patients with AMI were divided to the bivalirudin group(30 cases, A group); heparin group(30 cases, group B);heparin plus tirofiban group(30 cases, group C). Delivering methods: A group before the start of PCI procedures given bivalirudin 0.75mg/kg intravenous live as a loading dose immediately,and then given 1.75mg/kg/h continuous infusion until the end of surgery(at least maintain 30min);group B before the start of PCI give heparin 100U/kg; group C given heparin 60U/kg intravenous bolus before the start of PCI surgery plus preoperative within tirofiban for coronary(intravenous) bolus and continuous intravenous infusion,the starting dose was pushed live 10μg/kg, within three minutes of the push to live is completed, and then maintain intravenous infusion at a rate of 0.15μg/kg/min, the infusion can be maintained until 36 hours after surgery, when necessary. Assess the incidence of major adverse cardiac events [including urgent target vessel revascularization(TVR), postoperative myocardial infarction, stent thrombosis, death],and the incidence of bleeding events during the three groups of patients in hospital, 30 days after surgery, 6 months, and when 1 year.【 results 】 1. The three groups of patients between baseline clinical data were compared among the three groups of sex, age, family history of coronary heart diseaserisk factors [smoking history, hypertension, diabetes, stroke, peripheral vascular medical history, family history, previous myocardial infarction history, past surgical history PCI treatment, previous treatment history of CABG surgery, anemia, hyperlipidemia, heart disease, cancer] and other routine examination indicators: General information on the level of hemoglobin, serum creatinine, hemoglobin, platelet count, were not shown statistically Differences; 2. Three groups of patients infarct vessel positioning and surgical results between the three groups related to the distribution of the ratio of infarct artery after PCI TIMI3 flow grade incidence were no significant statistical significance;3.The efficacy and safety of treatment among three groups of three.Comparison: Compare in hospital: A, B, C three groups of patients did not occur cardiac death, acute stent thrombosis, myocardial infarction, TVR and other adverse cardiac events during hospitalization. A group had 1, B, C in each group had 2 patients with gastrointestinal bleeding(BARC bleeding score is Type1), after active treatment improved, three groups bleeding(3.3% vs6.7% vs6.7%, p = 0.809) no statistically significant, the three groups did not occur thrombocytopenia. Comparison after 30 days:in terms of efficacy, A group had 1 patients with acute myocardial infarction, Group B had 2,Group C had 1 patient who gets myocardial infarction(3.3% vs6.7% vs3.3%, p =0.770), there was no significant statistical difference. Three groups of patients had no heparin-induced thrombocytopenia. In terms of security: three groups were bleeding events(BARC bleeding score for Type1),(3.3% vs16.7% vs26.7%, p = 0.044), there was significant. Compare after six months: in terms of efficacy, each group A and group B had 1 patients gets cardiac death,.On myocardial infarction rate, all three groups have occurred(6.7% vs16.7% vs16.7%, p = 0.421), there was no difference statistically significant. In terms of security, A, B, C three groups of patients had bleeding adverse events occurred, of which group B, group C each had two patients with Type2 of bleeding, total bleeding three groups(6.7% vs33.3% vs36.7%, p = 0.014), the difference was statistically significant; Compare after 12 months: in terms of efficacy, group A and group B each had 1 patients gets cardiac death.On myocardial infarction incidence, all three group had occurred(6.7% vs16.7% vs16.7%, p = 0.421), the difference was not statistically significant. In terms of security, A, B, C three groups of patients had adverse events that occurred bleeding, total bleeding(16.7% vs46.7% vs43.3%, p = 0.029), the difference was statistically significant.【 conclusion 】 In patients with acute myocardial infarction(including acute ST segment elevation myocardial infarction and non-ST-segment elevation acute myocardial infarction) who receive percutaneous coronary intervention(PCI), bivalirudin using is safe and effective. Its reduction the incidence of adverse cardiac events with heparin or heparin among tirofiban are similar efficacy during hospitalization, 30 days after surgery,after 6 months and 1 year after surgery, but the incidence of bleeding events shows significantlyreduce. |
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