关绍义,王晓燕,李晶,荆全民,梁振洋,刘海伟,李毅,韩雅玲

• 1:沈阳军区总医院心内科

摘要(Abstract)：

目的探讨老年急性心肌梗死(acute myocardial infarction,AMI)患者急诊经皮冠状动脉介入治疗(percutaneous coronary interventions,PCI)围术期应用比伐芦定的疗效与安全性。方法选取BRIGHT研究中年龄≥65岁的老年AMI行急诊PCI患者659例,其中比伐芦定组205例,肝素组228例,肝素联合替罗非班组226例。主要终点为术后30 d净不良临床事件(net adverse clinical events,NACE),包括主要不良心脑血管事件(major adverse cardiac and cerebrovascular events,MACCE)和全部出血事件。次要终点为术后12个月的NACE事件及术后30 d和12个月的全部出血事件。安全性终点为术后30 d或12个月的支架内血栓。结果 (1)比伐芦定组术后30 d内NACE[25例(12.2%)比45例(19.9%),P=0.030]及全部出血事件[14例(6.8%)比34例(15.0%),P=0.007]发生率显著低于肝素联合替罗非班组;与肝素组相比有降低趋势[NACE:25例(12.2%)比43例(18.9%),P=0.057;全部出血事件:14例(6.8%)比25例(11.0%),P=0.133],但差异均无统计学意义。三组间术后30 d内MACCE和支架内血栓事件发生率比较,差异均无统计学意义(均P>0.05)。(2)比伐芦定组术后12个月NACE[32例(15.6%)比57例(25.2%),P=0.014]及全部出血事件[16例(7.8%)比39例(17.3%),P=0.003]发生率显著低于肝素联合替罗非班组;与肝素组相比有降低趋势[NACE:32例(15.6%)比48例(21.1%),P=0.145;全部出血事件:16例(7.8%)比29例(12.7%),P=0.094],但差异均无统计学意义。三组间术后12个月MACCE和支架内血栓事件发生率比较,差异均无统计学意义(均P>0.05)。结论老年AMI患者急诊PCI围术期应用比伐芦定安全有效,与肝素或肝素联合替罗非班相比,可降低术后30 d及12个月的NACE和出血事件风险,且不增加MACCE和支架内血栓风险。

关键词(KeyWords)： 比伐芦定;抗凝;急性心肌梗死;经皮冠状动脉介入治疗;老年

Abstract:

Keywords:

基金项目(Foundation): 辽宁省科技攻关项目(2013225089);; 军队临床高新技术重大项目(2010gxjs001)

作者(Author): 关绍义,王晓燕,李晶,荆全民,梁振洋,刘海伟,李毅,韩雅玲

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