探讨比伐芦定在接受经皮冠状动脉介入治疗(PCI)的老年冠状动脉(冠脉)慢性完全闭塞(CTO)病变患者的疗效.方法 连续入选2016年1月至2018年1月于辽宁省人民医院就诊明确诊断CTO病变的老年冠脉粥样硬化性心脏病(冠心病)患者118例.随机分为普通肝素(UFH)组(冠状动脉造影前给予2500 U,PCI前补充100 U/kg,每过1 h追加1000 U;66例)和比伐芦定组(0.75 mg/kg负荷量,续以1.75 mg/kg/h至术后4 h;52例).主要有效性终点定义为住院期间及出院后6个月的主要心血管不良事件(MACE)发生率.安全性终点是PCI后任何出血或者术区相关并发症.结果 比伐芦定组PCI后慢血流/无复流发生率(3.8% vs. 16.7%,P=0.037)、小出血发生率(17.3% vs. 34.8%,P=0.039)均显著低于UFH组.住院期间,比伐芦定组PCI相关心肌梗死发生率显著低于UFH组(9.6% vs. 25.8%,P=0.032);出院后6个月时间内,两组MACE发生率比较无统计学差异(P均＞0.05).结论 老年冠脉CTO病变患者PCI中使用比伐芦定抗凝治疗可降低无复流/慢血流和PCI相关急性心梗发生率,同时可降低术区出血相关并发症,不增加6个月MACE风险.
investigate the curative effect of bivalirudin in elderly patients with chronic total occlusion of coronary artery (CTO) undergone percutaneous coronary intervention (PCI). Methods CTO patients (n=118) were chosen from People’s Hospital of Liaoning Province from Jan. 2016 to Jan. 2018. All patients were divided randomly into unfractionated heparin group (UFH group, given 2500 U of UFH before coronary angiography, 100 U/kg before PCI, 1000 U every 1 h, n=66), and bivalirudin group (given 0.75 mg/kg of bivalirudin, 1.75 mg/kg/h continuously to 4 h after PCI, n=52). The main efficacy endpoint was defined as the incidence rate major adverse cardiovascular events (MACE) during hospitalization period and after discharged for 6 months. The safety endpoint was any bleeding and postoperative complications around PCI area. Results The incidence rates of slow flow/no-reflow (3.8% vs. 16.7%, P=0.037) and minor bleeding (17.3% vs. 34.8%, P=0.039) were significantly lower in bivalirudin group than those in UFH group after PCI. During hospitalization period, the incidence rate of PCI-related myocardial infarction was significantly lower in bivalirudin group than that in UFH group (9.6% vs. 25.8%, P=0.032). After discharged for 6 months, the incidence rate of MACE had no statistical difference between 2 groups (all P>0.05). Conclusion Bivalirudine as an anticoagulant used during PCI can reduce the incidence rates of slow flow/no-reflow, PCI-related myocardial infarction and bleeding-related complications around PCI area without increasing the risk of MACE for 6 months in elderly patients with CTO.