Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA.
JACC Cardiovasc Interv. 2010 Jun;3(6):669-77. doi: 10.1016/j.jcin.2010.03.015.
The aim of this study was to examine the use of and outcomes associated with antithrombotic strategies in patients with non-ST-segment elevation myocardial infarction (NSTEMI) who undergo percutaneous coronary intervention (PCI).
A variety of antithrombotic strategies have been tested in clinical trials for NSTEMI patients treated with PCI.
Antithrombotic strategies for NSTEMI patients undergoing PCI at 217 ACTION (Acute Coronary Treatment and Intervention Outcomes Network) hospitals from January 1, 2007, to December 31, 2007, (n = 11,085) were classified into commonly observed antithrombotic groups: heparin alone (Hep alone; low-molecular-weight heparin or unfractionated heparin), bivalirudin alone (Bival alone), heparin with glycoprotein IIb/IIIa inhibitors (Hep/GPI), and bivalirudin with GPI (Bival/GPI). Baseline characteristics are shown across treatment groups. In addition, unadjusted and adjusted rates of in-hospital major bleeding and death are shown.
The standard strategy used was Hep/GPI (64%), followed by Hep or Bival alone (28%), and Bival/GPI (8%). Patients who received Hep or Bival alone were older with more comorbidities, higher baseline bleeding and mortality risk, and lower peak troponin. Compared with patients who received Hep/GPI , those who received Hep alone and Bival alone had lower rates of major bleeding (adjusted odds ratio [OR]: 0.52; 95% confidence interval [CI]: 0.42 to 0.65; adjusted OR: 0.48; 95% CI: 0.39 to 0.60; respectively), yet only patients who received Bival alone had lower mortality (adjusted OR: 0.39; 95% CI: 0.21 to 0.71).
NSTEMI patients undergoing PCI are more likely to receive Bival or Hep alone when at higher baseline bleeding risk than when at lower baseline bleeding risk. Despite higher baseline risk, those receiving Bival or Hep alone had less bleeding.
本研究旨在探讨接受经皮冠状动脉介入治疗（PCI）的非 ST 段抬高型心肌梗死（NSTEMI）患者的抗栓策略的应用及相关结局。
临床试验已经测试了多种抗栓策略用于接受 PCI 的 NSTEMI 患者。
2007 年 1 月 1 日至 2007 年 12 月 31 日，ACTION（急性冠状动脉治疗和干预结果网络）网络 217 家医院接受 PCI 的 NSTEMI 患者的抗栓策略分为常见的抗栓治疗组：单独肝素（Hep 组；低分子肝素或普通肝素）、单独比伐卢定（Bival 组）、肝素联合糖蛋白 IIb/IIIa 抑制剂（Hep/GPI 组）和比伐卢定联合糖蛋白 IIb/IIIa 抑制剂（Bival/GPI 组）。治疗组之间显示了基线特征。此外，还显示了未调整和调整后的院内大出血和死亡发生率。
标准治疗策略是 Hep/GPI（64%），其次是 Hep 或 Bival 单独治疗（28%），Bival/GPI（8%）。单独接受 Hep 或 Bival 治疗的患者年龄较大，合并症较多，基线出血和死亡率较高，肌钙蛋白峰值较低。与接受 Hep/GPI 治疗的患者相比，单独接受 Hep 或 Bival 治疗的患者大出血发生率较低（调整后比值比[OR]：0.52；95%置信区间[CI]：0.42 至 0.65；调整后 OR：0.48；95%CI：0.39 至 0.60；分别），但只有单独接受 Bival 治疗的患者死亡率较低（调整后 OR：0.39；95%CI：0.21 至 0.71）。
与低基线出血风险患者相比，基线出血风险较高的 NSTEMI 患者行 PCI 时更倾向于接受单独比伐卢定或肝素治疗。尽管基线风险较高，但单独接受比伐卢定或肝素治疗的患者出血风险较低。
