Vergallo Rocco, Joye Russell, Barlis Peter, Jia Haibo, Tian Jinwei, Soeda Tsunenari, Minami Yoshiyasu, Hu Sining, Dauerman Harold L, Toma Catalin, Chan James, Lee Hang, Biasucci Luigi Marzio, Crea Filippo, Jang Ik-Kyung
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Catheter Cardiovasc Interv. 2015 Mar;85(4):575-82. doi: 10.1002/ccd.25631. Epub 2014 Aug 22.
This study aimed to compare the effect of bivalirudin and unfractionated heparin (UFH) on residual thrombus burden assessed by frequency-domain optical coherence tomography (FD-OCT), and on angiographic indices of microvascular obstruction (MVO).
The efficacy of bivalirudin to inhibit thrombus formation inside the stent during percutaneous coronary interventions (PCI) as compared to UFH is unknown.
Sixty patients with coronary artery disease who underwent post-PCI FD-OCT were studied, including 20 patients treated with bivalirudin and 40 control patients treated with UFH, matched by clinical presentation, stent characteristics, and periprocedural medications. In-stent thrombus volume, thrombus score (number of quadrants with thrombus), and thrombus type (white/red) were assessed by FD-OCT. Thrombolysis in myocardial infarction (TIMI) flow grade, corrected TIMI frame count (cTFC), and Quantitative Blush Evaluator (QuBE) score were recorded.
Patients treated with bivalirudin showed similar thrombus volume (0.14 mm(3) [0.00-0.88] vs. 0.13 mm(3) [0.00-0.63], P = 0.962), thrombus score (10 [0-25] vs. 8 [0-21], P = 0.849) and thrombus length (1.70 mm [0.00-4.10] vs. 1.40 mm [0.00-4.05], P = 0.968], as compared with patients treated with UFH. Patients in the bivalirudin group showed lower proportion of white thrombus (55.5% vs. 78.6%, P = 0.016). There was no significant difference in TIMI flow grade, cTFC, and QuBE score between the two groups.
The present study showed similar residual thrombus burden and angiographic indices of MVO immediately after PCI between patients treated with bivalirudin and those treated with UFH.
本研究旨在比较比伐卢定和普通肝素（UFH）对通过频域光学相干断层扫描（FD-OCT）评估的残余血栓负荷以及对微血管阻塞（MVO）血管造影指标的影响。
与UFH相比，比伐卢定在经皮冠状动脉介入治疗（PCI）期间抑制支架内血栓形成的疗效尚不清楚。
对60例行PCI术后FD-OCT检查的冠心病患者进行研究，其中20例接受比伐卢定治疗，40例接受UFH治疗的对照患者，根据临床表现、支架特征和围手术期用药进行匹配。通过FD-OCT评估支架内血栓体积、血栓评分（有血栓的象限数）和血栓类型（白色/红色）。记录心肌梗死溶栓（TIMI）血流分级、校正TIMI帧数（cTFC）和定量 blush 评估器（QuBE）评分。
与接受UFH治疗的患者相比，接受比伐卢定治疗的患者显示出相似的血栓体积（0.14 mm³[0.00 - 0.88] vs. 0.13 mm³[0.00 - 0.63]，P = 0.962）、血栓评分（10[0 - 25] vs. 8[0 - 21]，P = 0.849）和血栓长度（1.70 mm[0.00 - 4.10] vs. 1.40 mm[0.00 - 4.05]，P = 0.968）。比伐卢定组患者的白色血栓比例较低（55.5% vs. 78.6%，P = 0.016）。两组之间的TIMI血流分级、cTFC和QuBE评分无显著差异。
本研究表明，PCI术后立即接受比伐卢定治疗的患者与接受UFH治疗的患者相比，残余血栓负荷和MVO血管造影指标相似。
