高血压对经皮冠状动脉介入术围手术期应用比伐芦定的安全性和有效性的影响

摘要/Abstract

摘要： 目的探究高血压对经皮冠状动脉介入术（percutaneous coronary intervention,PCI）围手术期应用比伐芦定的安全性和有效性的影响。方法入选2018年6月至2019年6月诊断为冠心病不稳定性心绞痛,行PCI治疗且围手术期应用比伐芦定的患者,收集相关临床数据,对所有患者进行为期1年的随访。比较高血压组和非高血压组主要不良心血管事件（major adverse cardiovascular event,MACE）和出血事件的发生率。结果随访30天,高血压组与非高血压组相比,MACE的发生未见显著异常（P>0.05）,小出血事件的发生率增高（P<0.05）,严重出血事件未见增加（P>0.05）。随访1年,高血压组的MACE、小出血的发生率增高（P<0.05）,严重出血事件的发生率无显著性差异（P>0.05）。Logistic回归分析发现,高血压并不是近期及远期MACE和出血事件的独立影响因素（P>0.05）。结论高血压患者PCI围手术期中应用比伐芦定具有较好的有效性和安全性,可降低严重出血的风险。

关键词: 高血压, 经皮冠状动脉介入术, 比伐芦定, 出血事件

解存, 肖红缨, 韩旭. 高血压对经皮冠状动脉介入术围手术期应用比伐芦定的安全性和有效性的影响[J]. 心血管病防治知识, 2023, 13(3): 26-29.

参考文献

[1] Capodanno D,de Caterina R. Bivalirudin for acute coronary syndromes: premises,promises and doubts[J].Thromb Haemost,2015,113(4): 698-707.
[2] 古力尼沙汗·如孜,王宝珠,凯丽曼·阿布都米吉提,等.肝素与比伐芦定在接受静脉-动脉体外膜肺氧合辅助患者中的抗凝安全性和有效性的对比研究[J].中国介入心脏病学杂志,2022,30(5):366-373.
[3] 刘育慧,李云贺,耿清峰,等.急诊高危行经皮冠脉介入术患者围手术期应用比伐芦定与肝素抗凝效果、主要心血管不良事件发生率及临床疗效比较[J].中国分子心脏病学杂志,2022,22(2):4561-4566.
[4] Abu-Assi E,Gracía-Acua JM,Ferreira-González I,et al. Evaluating the Performance of the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) bleeding score in acontemporary Spanish cohort of patients with non-ST-segment elevation acute myocardial infarction[J].Circulation, 2010,121:2419-2426.
[5] 急性冠状动脉综合征抗栓治疗合并出血防治多学科专家共识[J].中华内科杂志,2016,55(10):813-824.
[6] 向定成,顾晓龙,潘春梅,等.国产比伐芦定用于冠状动脉介入治疗术中抗凝的疗效和安全性评价[J].中国循环杂志,2011,26(5):331-334.
[7] 李世英,柳景华.欧美出血学术研究会(BARC)关于出血的统一定义[J].中国介入心脏病学杂志,2012,20:231-234.
[8] 张良,邸伟庆,陈阳等.直接凝血酶抑制剂研究进展[J].海峡药学,2017,29(1):1-5.
[9] Vikram Khanna, Adeel Shahzad, Kala Thayalasamy,et al.Comparison of the antiplatelet and antithrombotic effects of bivalirudin versus unfractionated heparin: A platelet substudy of the HEAT PPCI trial[J]. Thromb Res,2018,172:36-43.
[10] Valgimigli Marco, Frigoli Enrico, Leonardi Sergio, et al. Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial.[J]. Lancet (London, England),2018. Intervention[J]. J Am CollCardiol, 2019, 73(22): 2846-2855.
[11] Gargiulo Giuseppe, da Costa Bruno R, Frigoli Enrico, et al. Impact of sex on comparative outcomes of bivalirudin versus unfractionated heparin in patients with acute coronary syndromes undergoing invasive management: a pre-specified analysis of the MATRIX trial.[J]. EuroIntervention,2019,15(3):e269-e278.
[12] Liu XQ, Luo XD, Wu YQ. Efficacy and safety of bivalirudinvs heparin in patients with coronary heart disease undergoing percutaneous coronary intervention: A meta-analysis of randomized controlled trials[J]. Medicine (Baltimore),2020, 99(6): e19064
[13] 周福亮,于云霞,梁长彬,等. 比伐芦定与肝素在经皮冠状动脉介入治疗中有效性及安全性的Meta分析[J]. 药物流行病学杂志,2018, 27(10): 640-646.
[14] Wester A, Attar R, Mohammad MA,et al. Bivalirudin Versus Heparin Monotherapy in Elderly Patients With Myocardial Infarction: A Prespecified Subgroup Analysis of the VALIDATE-SWEDEHEART Trial[J]. Circ Cardiovasc Interv, 2020,13(4):e008671.
[15] Sarah R Blake, Adeel Shahzad, Ian Kemp, et al. Twelve-month mortality from the “How Effective are Antithrombotic Therapies in Primary Percutaneous Coronary Intervention (HEAT-PPCI) Trial”[J]. Int J Cardiol,2020,310:37-42.
[16] Zullig LL, Liang Y, Vale Arismendez S, et al. Trajectory of systolic blood pressure in a low-income, racial-ethnic minority cohort with diabetes and baseline uncontrolled hypertension[J]. J Clin Hypertens(Greenwich),2017,19(7):722-730.
[17] Lee SW, Kim HC, Lee JM,et al. Association between changes in systolic blood pressure and incident diabetes in a community-based cohort study in Korea[J]. Hypertens Res,2017,40(7):710-716.
[18] Warren J, Nanayakkara S, Andrianopoulos N, et al. Impact of Pre-Procedural Blood Pressure on Long-Term Outcomes Following Percutaneous Coronary Intervention[J]. J Am Coll Cardiol,2019,73(22):2846-2855.
[19] Garcia-Garcia HM, Adamo M, Soud M, et al. Assement of residual thrombus burden in patients with ST-segment elevation myocardial undergoing bivalirudin versus unfractional heparin infusion:the MATRIX (minimizing adverse hemorrhagic events by transradial access site and angioX) OCT study[J]. Catheter Cardiovasc Interv,2020,96(6):1156-1171.