| Objective: To investigate the correlation between the global registry of acute coronary events(GRACE)risk score and compliance of activated clotting time(ACT)with unfractionated heparin(UFH)during percutaneous coronary intervention(PCI)in patients with acute non-ST-segment elevation myocardial infarction(NSTEMI),to analyze the predictive value of GRACE score on heparin resistance(HR)during PCI,and to further investigate the influencing factors affecting the compliance of heparin anticoagulation in patients with NSTEMI.Methods: Patients who were admitted to the Inner Mongolia People’s Hospital of from November 2021 to November 2022 for NSTEMI and anticoagulated with UFH during PCI were selected,the patients were divided into three groups according to the GRACE risk score: scores ≤108 for the low-risk group,109-140 for the intermediate-risk group,and >140 for the high-risk group.50 patients in each group were consecutively included,totaling 150 patients.The patients were given UFH at100 U/kg during PCI,and ACT values were measured at 20 min after administration.ACT≥250s means that the heparin anticoagulation has reached the standard,and <250s means that the heparin anticoagulation has not reached the standard.All patients’ relevant clinical data and medical history were collected,including body mass index(BMI),history of hypertension,history of diabetes,platelet(PLT),hemoglobin(Hb),hypersensitive C-reactive protein(hs-CRP),serum creatinine level,fibrinogen(FIB),Application of nitroglycerin in PCI and so on.to analyze the correlation between GRACE risk score and heparin anticoagulation status.to summarize the predictive value of GRACE risk score for heparin resistance,to observe the major adverse cardiovascular events(MACE)in each group 30 days after PCI treatment,and to discuss the influencing factors leading to heparin resistance in NSTEMI patients during PCI.Results:(1)When patients were given a therapeutic dose of UFH at 100 U/kg during PCI and ACT levels were measured at 20 minutes of administration,the ACT measurement value of the low-risk group was 346.92±87.41 s,and the UFH anticoagulant compliance rate was 92%.The ACT measurement value of the intermediate-risk group was 317.50±93.87 s,and the compliance rate was 80%.the ACT measurement value of the high-risk group was 273.06±67.07 s,and the compliance rate was only 48%.regarding the ACT measurements and anticoagulant compliance rate(ACT≥250s),a pairwise comparison among the three groups showed that there were statistically significant difference between the high-risk group and the intermediate-risk,and between the high-risk group and low-risk group,respectively(P<0.05),while there were no statistically significant difference between the intermediate-risk and low-risk groups(P>0.05).(2)Among the related MACE events after PCI,the low-risk group accounted for 6%(3 cases),the intermediate-risk group accounted for 8%(4 cases),and the high-risk group accounted for 28%(14 cases).The incidence of postoperative MACE events was statistically different among the three groups(χ~2=12.292,P=0.002).The incidence of MACE events in the high-risk group was significantly higher than that in the low-risk and intermediate-risk groups(P<0.05),while the number of MACE cases in the intermediate-risk group was slightly higher than that in the low-risk group,but there was no statistical difference between the two groups(P>0.05).(3)In the 150 patients with NSTEMI who underwent PCI,the number of patients who achieved heparin anticoagulation were110 cases and the number of patients who did not achieve the standard were 40 cases in the three groups.The correlation analysis between the compliance of heparin anticoagulation duiring PCI and the clinical data of patients showed that,there were statistical difference between those who achieved the standard and those who did not achieve the standard in terms of hs-CRP,fibrinogen,PLT,GRACE risk score and killip classification,etc.(P<0.05).Multivariate logistic regression analysis showed that high PLT count,high risk GRACE score,high hs-CRP index,high FIB level and killip grade II or higher were influential factors leading to heparin resistance during PCI(P<0.05).Conclusions:(1)GRACE score can assist in determining the potential risk of heparin resistance during operation in NSTEMI patients,and has a high predictive value for postoperative adverse events and prognosis in NSTEMI patients.(2)GRACE high-risk score,high PLT count,high hs-CRP index,high FIB level and killip grade II or higher are important influencing factors for heparin resistance in patients undergoing PCI.(3)For NSTEMI patients with high thrombosis risk status caused by the above factors,if anticoagulation is not up to standard during PCI Patients may consider increasing the dose of heparin,or switch to other new anticoagulant drugs. |
