The Effect Of Bivarudine On Cardiac Function And Its Safety During PCI In Patients With ST-Segment Elevation Acute Myocardial Infarction

ObjectiveTo investigate the effect of bivarudin injection on cardiac function and bleeding safety during PCI in patients with st-segment elevation acute myocardial infarction.Materials and methods1.1 research objects and groupingPatients were screened strictly according to enrollment and exclusion criteria.102 cases of STEMI patients,including 60 males and 40 females aged 18-80 years,who were diagnosed with emergency PCI in jinan central hospital from March 2017 to October 2018 and planned to undergo emergency PCI were selected.The patients were randomly divided into 2 groups,including 51 cases of bivarudin(The experimental group)and 51 cases of heparin(The control group).A prospective,randomized,single-center clinical trial design was used.This study was agreed by the ethics committee of economic south central hospital.All enrolled patients understood the experimental procedures and signed the informed consent.1.2 method1.2.1 treatment group A and group B were given oral aspirin of 300 mg,clopidogrel of 600 mg or ticagrelor of 180 mg in the emergency department,and group A was preoperatively injected with 0.75 mg /kg load dose of Shenzhen Salubris Pharmaceuticals Co.,Ltd.,followed by 1.75 mg/(kg·h)intravenous pumping for 4h postoperatively.Enoxaparin 100 U/kg,bid were injected subcutaneously for a total of 7 days.All operations were completed within 1 hour.Heparin sodium injection 100U/kg was given to group B before PCI,and tirofiban 10 g/kg was routinely injected intraoperatively into the coronary arteries of the two groups,followed by continuous pumping of 0.375~0.75 g/(kg·min)for 24~36 h.During the operation,patients with high thrombotic load were routinely treated with thrombolysis,patients with arrhythmia were routinely treated with defibrillation,and drug-eluting stents were implanted into the blood vessels of criminals.Criteria for successful operation: grade 3 TIMI,residual stenosis in stent < 20%.Postoperative aspirin 100 mg/d and clopidogrel 75 mg/d or tigreglio 90 mg bidwere routinely used.Postoperative routine application to improve myocardial remodeling,blood pressure,hypoglycemic,improve circulation,control ventricular rate,diuresis and other routine myocardial infarction after treatment.1.3 blood flow grading standard for myocardial infarction(TIMI)blood flow grading standardGrade 0: no perfusion,no forward flow(contrast agent)filling at occlusion site and distal end;Grade 1: microperfusion.Contrast agent passed through the occlusion,but no contrast agent passed the distal anterior blood flow of the occlusion segment at any moment.Grade 2: partial perfusion.The contrast agent passed through the occlusion segment and reached the distal vessels,but the filling rate was significantly slower than that of the normal vessels.Stage 3: total perfusion,rapid and complete filling of distal vessels with forward flow.1.4 observation indexes48 hours(1)in patients with postoperative adept bed heart colour to exceed,observed in patients with left ventricular diastolic diameter and ejection fraction,and myocardial infarction with 24 hours after preoperative coagulation routine,hemoglobin change(2)records within 30 days after PCI therapy of two groups of patients with malignant cardiac events,including death,recurrence of angina pectoris,again hair q-wave myocardial infarction,stent thrombosis)malignant arrhythmia and sudden death,etc.Significant bleeding was recorded in the two groups,such as massive gastrointestinal hemorrhage,cerebral hemorrhage,nasal hemorrhage and large amounts of other parts requiring emergency treatment,and the clinical grade of bleeding was evaluated.ResultsThere was no significant difference in age,hypertension,diabetes,hyperlipidemia and other cardiovascular risk factors between the control group and the experimental group(P>0.05).Of cardiac function,There was no statistical difference on basic BNP between the two groups(485.75± 647.40)v s.968.11± 889.35,P =0.184;Compared with the heparin group,the basic TNT level and the postoperative 24-hour TNT level were significantly lower in the varudine group than in the heparin group,but the difference was not statistically significant(224.73±412.45 v s.570.18±1181.52,P = 0.055).The difference in the basic creatinine level and the postoperative 24-hour creatinine level between the experimental group and the control group was not statistically significant(44.84±42.25 v s.85.21±44.34,P = 0.061).There was no significant difference in urea level between the experimental group and the control group 24 hours after surgery(16.29±28.58 v s.6.34±8.18,P = 0.394).Basic creatinine level and ascending aortic diameter 24 hours after surgery in the experimental group and the control group were significantly improved compared with the control group(28.45±2.70 v s.29.88±3.57,P = 0.024).In the experimental group and the control group,24 hours after surgery,the improvement effect of the experimental group was better than that of the control group,and the difference was statistically significant(11.11±1.31 v s.10.18±1.17,P =0.000).Left ventricular diastolic dysmenorrhea was improved in the experimental group and the control group 24 hours after surgery.The improvement effect in the experimental group was better than that in the control group,and the difference was statistically significant(47.49±4.79 v s.50.80±4.22,P =0.000).Postoperative ejection fraction of the experimental group and the control group was significantly different from that of the control group(57.68±6.84 v s.59.72±6.21%,P =0.117).There was no significant difference in c-reactive protein 24 hours after surgery between the experimental group and the control group(18.57±22.16 v s.16.91±23.30,P =0.713).Compared with the heparin group,varudine had statistical significance in postoperative bleeding,and the risk of bleeding was relatively reduced.For elderly patients with high risk of bleeding,the application of varudine was more effective,and the improvement in the level of coagulation factors was better(APTT33.25±16.01 v s.26.47±7.27,P=0.044).However,there was no significant difference in coagulation.Compared with the normal heparin group,the TIMI grade 3 blood flow acquisition rate of the infarct-related vessels after surgery was similar,and the difference was not statistically significant.Conclusion: in the urgent treatment of PCI for patients with acute ST segment elevation myocardial infarction,the risk of bleeding in the application of varudine was lower than that in the common heparin group,and there was no significant difference in coagulation.The effect was better for the elderly.It is suggested to continue to apply in emergency percutaneous coronary intervention.In terms of postoperative effects on cardiac function,there were no statistically significant differences in renal function and inflammatory indicators,showing no obvious advantages.It has advantages in the improvement of cardiac structure(but the possibility of low sample size cannot be excluded),and further big data research is still needed in the recovery of postoperative myocardial infarction area and cardiac function.conclusion1.Bivarudine vial has no effect on cardiac function after emergency PCI in STEMI patients,It may be associated with reduced inflammation;2.Comparison of heparin with bivaludine in the emergency PCI treatment of STEMI patients with low bleeding risk and no difference in anticoagulant effect.The effect of reducing intraoperative bleeding risk is good,and clinical recommendation is recommended.