Study On The Safety Of Bivarutine Combined With Tegrilol In The Emergency PCI Of STEMI Patients

Objective: To explore the safety of bivarutine combined with tegrarol in the emergency PCI of STEMI patients.Methods: In this study,STEMI patients who were admitted to the first people’s Hospital of Yulin City from October 1,2018 to December 30,2019 for emergency PCI were divided into bevaludine group(group A)and unfractionated heparin group(group B).All eligible patients were given aspirin(300mg)orally before PCI,and then 100 mg/d after PCI.At the same time,tegrilol(180 mg)orally,and then 90 mg / bid after PCI.We all formulated the drug plan according to the latest STEMI diagnosis and treatment guidelines,closely observed the patient’s condition changes,and adjusted the drug according to the actual situation of the patients.Two skilled surgeons performed emergency PCI,thrombus aspiration and stent implantation according to the specific conditions during the operation.The clinical adverse events and bleeding events were observed 30 days after operation.Results: 1.In this study,210 STEMI patients were included through strict screening,and all of them met the pre-determined inclusion criteria.According to the order of admission and the random number table,we divided the patients into two groups: bevaludine group 105 and unfractionated heparin group 105.Through our close follow-up,the two groups of patients did not lose the follow-up during the observation period of this study.Finally,105 patients were selected into bevaludine group and 105 patients in unfractionated heparin group.Through statistical analysis,we found that there was no statistical difference in the basic clinical data of bevaludine group and unfractionated heparin group,including gender,age,hypertension in previous history,diabetes,smoking in personal history,heart function grading,and the time required from patients to hospital diagnosis and treatment to balloon dilatation during PCI(D2B)(P>0.05).2.According to the results of coronary angiography,the TIMI blood flow classification of criminal coronary artery before PCI was observed and counted.In bivarutine group,the TIMI blood flow classification of criminal blood vessel before PCI reached grade 0 in 64 cases,grade 1 in 12 cases,grade 2 in 9 cases,and grade 3 in 20 cases;in heparin group,the TIMI blood flow classification of criminal blood vessel was grade 0 in 73 cases,grade 1 in 6 cases,grade 2 in 7cases,and grade 3 in 19 cases.There was no significant difference in TIMI blood flow classification between bevaludine group and unfractionated heparin group before PCI.After emergency PCI,angiography showed that the blood flow of criminals in the two groups improved after PCI.There were 102 patients with TIMI Level3 and 3 patients with TIMI Level 2 in bevaludine group,102 patients with TIMI Level 3 and 3 patients with TIMI Level 2 in unfractionated heparin group.There was no statistical difference in the blood flow of criminals in the two groups after PCI.3.Through the observation of postoperative hospitalization,outpatient visit and telephone follow-up,the incidence of bleeding in bevaludine group and unfractionated heparin group was statistically analyzed: 30 days after emergency PCI,no major bleeding occurred in both groups;there were 5 cases of bleeding in bevaludine group,1 case of secondary bleeding and 4 cases of slight bleeding.In the unfractionated heparin group,there were 14 cases of bleeding,1case of secondary bleeding and 13 cases of slight bleeding.There was less bleeding in the group of bivalutine than that in the group of unfractionated heparin,and there was a significant decrease in slight bleeding in the group of bivalutine(3.8% vs.12.4%,P = 0.040).4.The patients were followed up for 30 days by outpatient and telephone,One patient died in unfractionated heparin group,but no death or other adverse clinical events occurred in bevaludine group.There was no statistical difference in death,myocardial infarction and revascularization 30 days after operation between bivalutine group and unfractionated heparin group.Conclusion: Bivalirudin combined with tegrarol significantly reduced the incidence of minor bleeding events in STEMI patients undergoing emergency PCI compared with unfractionated heparin combined with tegrarol.There was no significant difference in mace events such as death 30 days after follow-up.