Effect Of Anticoagulant Drug Selection On Short-term Prognosis Of ACS Patients With Different Risk Stratifications During PCI

Objective: To observe and compare the perioperative efficacy and safety of heparin or bivalirudin in patients with acute coronary syndrome risk stratified by different GRACE scores after percutaneous coronary intervention.Methods: 380 patients with acute coronary syndrome were enrolled,and according to GRACE score,the patients were divided into 267 cases of low-medium risk and 113 cases of high-risk,and then according to different anticoagulant regimens,the group of low-risk bleeding patients was divided into low-medium risk heparin group 130 cases.There were 137 cases in the low-medium risk bivalirudin group,37 cases in the high-risk heparin group,and 76 cases in the high-risk bivalirudin group.The incidence of major adverse cardiovascular events(MACE)and bleeding events in each group were observed and compared 24 hours and 30 days after operation.Results:There was no significant difference in the incidence of stent thrombosis and recurrent myocardial infarction between the heparin group and the bivalirudin group(P>0.05);there were statistically significant differences in the incidence of death and MACE(P<0.05).There was no significant difference in the incidence of MACE events,stent thrombosis,death,and recurrent myocardial infarction between the low-risk and intermediate-risk heparin groups and the bivalirudin group(P>0.05);Among the high-risk patients with GRACE score,there were 3 cases of MACE in the high-risk bivalirudin group and 8 cases in the high-risk heparin group.There was a statistically significant difference in the incidence of MACE between the two groups(P<0.05).There were 3 deaths in the high-risk bivalirudin group and 8 deaths in the high-risk heparin group.There was a statistically significant difference in all-cause mortality between the two groups(P<0.05).There were 3 bleeding events in the bivalirudin group and 19 bleeding events in the heparin group,and the difference between the two groups was statistically significant(P<0.05).There were 10 bleeding events in the high-risk heparin group and 10 bleeding events in the high-risk heparin group,and the difference in the incidence of bleeding events between the two groups was statistically significant(P<0.05).There was a significant difference(P<0.05).Compared with the heparin group,the probability of gastrointestinal bleeding in the bivalirudin group was significantly different(P<0.05).30-day adverse events The incidence of MACE events in the bivalirudin group was lower than that in the high-risk heparin group(P<0.05).Conclusion: Compared with heparin,the perioperative use of bivalirudin after PCI in high-risk ACS patients can reduce the risk of bleeding and all-cause mortality.Use of bivalirudin in lowand intermediate-risk patients reduced the risk of bleeding but not death.There was no significant difference between the two drugs in the risk of stent thrombosis.Before PCI,patients with ACS should evaluate their risk by GRACE score and choose appropriate anticoagulant drugs.