Comparison of the efficacy and safety between Bivalirudin and Heparin during emergency percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction

Abstract

Objective To compare the efficacy and safety between Bivalirudin and Heparin during emergency percutaneous coronary intervention(PCI)in elderly patients with acute ST-segment elevation myocardial infarction(STEMI). Methods Retrospective analysis of 80 patients diagnosed with ST-segment elevation myocardial infarction in elderly patients was conducted.The treatment group(n=40)received a bolus intravenous injection of Bivalirudin 0.75 mg/kg before emergency percutaneous coronary intervention, then 1.75 mg·kg-1·h-1continuous intravenous drip till the end of the operation from March 2011 to March 2015.Activated clotting time(ACT)was detected at 10 minutes after drug application.If ACT<225 s, 0.3 mg/kg were append.The control group received a bolus intravenous injection of Heparin 100 U/kg during emergency PCI, and after 10 minutes ACT was detected.If ACT<225 s, 300 U was appended.When operation extended, 1 000 U was appended every 1 hour.Immediate postoperative blood flow, early stent thrombosis, target vessel reconstruction at 30 days after operation, recurrent myocardial infarction, non-fatal cerebrovascular accident, all causes mortality and bleeding conditions at 7 days after operation were compared between two groups. Results The immediate postoperative thrombolysis in myocardial infarction(TIMI)blood flow was significantly improved(P 0.05). The bleeding conditions at 7 days after operation were significant lower in the treatment group[2.5%(1 case)]than in the control group[22.5%(9 cases)](χ2=7.31, P<0.01). Conclusions Bivalirudin treatment does not reduce the major cardiovascular events, but improves the TIMI blood flow after surgery and the incidence of bleeding as compared with control group, which suggests that Bivalirudin is safer in emergency PCI therapy in elderly patients with acute ST-segment elevation myocardial infarction Key words: Anticoagulants; Myocardial infarction; Angioplasty, intervention, percutaneous coronary