比伐卢定在冠状动脉分叉病变介入治疗中的疗效观察

项朝君; 毛琦; 田京都; 郑薇; 王玉清; 周渝; 赵晓辉

doi:10.16016/j.1000-5404.201909123

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比伐卢定在冠状动脉分叉病变介入治疗中的疗效观察

临床医学 | 更新时间：2026-01-09

- 比伐卢定在冠状动脉分叉病变介入治疗中的疗效观察
- Efficacy and safety of bivalirudin in percutaneous coronary intervention for coronary bifurcation lesions
- 第三军医大学学报 2019年41卷第22期页码：2223-2228
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院全军心血管病研究所
- 作者简介：
  
  [赵晓辉，E-mail:doctorzhaoxiaohui@yahoo.com ZHAO Xiaohui, E-mail:doctorzhaoxiaohui@yahoo.com
- 基金信息：
  
  国家自然科学基金面上项目(81670428)
- DOI：10.16016/j.1000-5404.201909123
  中图分类号： R541.4;R814.47;R973.2
- 收稿：2019-09-17，
  
  修回：2019-10-09，
  
  纸质出版：2019-11-30
- 稿件说明：
移动端阅览
项朝君, 毛琦, 田京都, 等. 比伐卢定在冠状动脉分叉病变介入治疗中的疗效观察[J]. 第三军医大学学报, 2019,41(22):2223-2228.

Chaojun XIANG, Qi MAO, Jingdu TIAN, et al. Efficacy and safety of bivalirudin in percutaneous coronary intervention for coronary bifurcation lesions[J]. Journal of Third Military Medical University, 2019, 41(22): 2223-2228.
项朝君, 毛琦, 田京都, 等. 比伐卢定在冠状动脉分叉病变介入治疗中的疗效观察[J]. 第三军医大学学报, 2019,41(22):2223-2228. DOI： 10.16016/j.1000-5404.201909123.

Chaojun XIANG, Qi MAO, Jingdu TIAN, et al. Efficacy and safety of bivalirudin in percutaneous coronary intervention for coronary bifurcation lesions[J]. Journal of Third Military Medical University, 2019, 41(22): 2223-2228. DOI： 10.16016/j.1000-5404.201909123.

摘要

目的

观察比伐卢定应用于冠状动脉分叉病变介入治疗中的有效性和安全性。

方法

本研究为回顾性队列研究，连续纳入2016年1~12月于本所经冠脉造影明确的329例冠脉分叉病变介入治疗患者。按照抗凝方式不同分为肝素组(178例)和比伐卢定组(151例)。统计两组患者的临床资料特征(性别、年龄、危险因素等)与冠脉病变情况，并随访两组患者PCI术后24 h、7 d、1年的主要不良心血管事件(major adverse cardiovascular events

MACE)及出血发生事件，其中MACE包括:死亡、心肌梗死、靶血管再次血管重建、脑卒中，而出血事件参照BARC出血分级标准进行评估。

结果

两组患者在人口学资料、既往病史、ACS比例、重要实验室指标和药物治疗方面基线数据差异无统计学意义。在分叉病变特征方面，两组患者的分叉病变位置、分叉病变类型、真分叉比例、主支及分支血管的长度和直径差异均无统计学意义。在PCI术后24 h内及1周内，两组均无MACE发生；肝素组有3例患者出现出血事件，无主要出血事件发生；比伐卢定组有5例患者出现出血事件，主要出血事件1例；两组间差异无统计学意义(

=0.477，

=0.459)。随访12个月后，肝素组有20例患者出现MACE，比伐卢定组有15例患者出现MACE，多因素分析显示比伐卢定对分叉病变冠脉介入治疗术后的MACE较肝素组无明显差异(

=0.839，95%

:0.420~1.676，

=0.619)。随访12个月后，肝素组有49例患者出现出血事件，主要出血事件6例；比伐卢定组有27例患者出现出血事件，主要出血事件3例；多因素分析显示比伐卢定较肝素显著减少分叉病变介入术后患者出血事件的风险(

=0.557，95%

:0.355~0.937，

=0.026)；而在主要出血事件风险方面，两者间无明显差异(

=0.535

95%

:0.130~2.206，

=0.387)。

结论

对冠状动脉分叉病变介入治疗患者随访12个月，比伐卢定较普通肝素显著降低出血风险，而并不增加MACE发生率。

Abstract

Objective

To investigate the efficacy and safety of bivalirudin in percutaneous coronary intervention (PCI) for coronary bifurcation lesions.

Methods

This retrospective cohort study was conducted among 329 consecutive patients with coronary artery bifurcation lesions confirmed by coronary angiography and underwent PCI in our institute between January

2016 and December

2016. All the patients received anticoagulation treatment with bivalirudin (151 cases) or heparin (178 cases). The demographic and clinical data of the patients (including gender

age

and risk factors) and the conditions of the coronary artery lesions were compared between the 2 groups. In 24 h

7 d and 12 months after the procedure

the incidences of main adverse cardiovascular events (MACE

including death

myocardial infarction

revascularization of the target vessel

and stroke) and bleeding were recorded after PCI. The bleeding endpoint was assessed in line with the BARC criteria for grading bleeding.

Results

No significant differences were

found between the 2 groups in the baseline data (including the demographic data

medical history

proportion of acute coronary syndrome

important laboratory indicators

and drug treatment)

nor in the characteristics of bifurcation lesions (including the lesion position

lesion type

true bifurcation ratio

length and diameter of the main branches and the branch vessels). In 24 h and 1 week after PCI

no MACE occurred in both groups. Bleeding and observed in 3 cases of the heparin group

but no major bleeding event was seen. In the bivalirudin group

there were 5 cases experiencing bleeding and 1 having major bleeding event. But no significant differonce was seen between the 2 groups (

=0.447

=0.459). Within 12 months after PCI

MACE occurred in 20 patients in the heparin group and in 15 patients in the bivalirudin group. Multivariate analysis showed that bivalirudin did not significantly affect the incidence of MACE after PCI compared with heparin (

=0.839

95%

: 0.420-1.676

=0.619). During the 12-month follow-up

49 patients in the heparin group had bleeding events (including major bleeding events in 6 patients)

as compared with 27 patients in the bivalirudin group (including 3 major bleeding events). Multivariate analysis further showed that compared with heparin

bivalirudin significantly reduced the risk of bleeding events in patients with bifurcation lesions after PCI (

=0.557

95%

: 0.355-0.937

=0.026)

but did not significantly affect the risk of major bleeding events (

=0.535

95%

: 0.130-2.206

=0.387).

Conclusion

In patients undergoing PCI for coronary bifurcation lesions

anticoagulation therapy with bivalirudin significantly reduces the risk of bleeding as compared with unfractionated heparin without increasing the incidences of MACE at 12 months after PCI.

关键词

Keywords

references

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