Lee Michael S, Shlofmitz Evan, Nayeri Arash, Hollowed John, Kong Jeremy, Shlofmitz Richard A
UCLA Medical Center, 100 Medical Plaza, Suite 630, Los Angeles, CA 90095 USA.
J Invasive Cardiol. 2017 Nov;29(11):397-400.
We compared the angiographic and clinical outcomes of heparin and bivalirudin in patients who underwent orbital atherectomy for severely calcified coronary lesions.
Severely calcified coronary lesions are associated with increased ischemic complications. Orbital atherectomy modifies calcified plaque, thereby facilitating stent delivery and stent expansion. The ideal antithrombotic agent during orbital atherectomy is unknown. Previous studies reported that bivalirudin was associated with lower bleeding rates compared with heparin plus glycoprotein IIb/IIa inhibitors during percutaneous coronary intervention.
This retrospective multicenter analysis included 458 consecutive real-world patients with severely calcified coronary arteries who underwent orbital atherectomy. Patients were stratified based on the antithrombotic agent that was used. The primary safety endpoint was the 30-day rate of major adverse cardiac and cerebrovascular events, defined as death, myocardial infarction, target-vessel revascularization, and stroke.
Heparin was used in 356/458 cases (77.2%) and bivalirudin was used in 102/458 cases (22.8%). The primary endpoint was similar in the heparin and bivalirudin groups (2% vs 3%; P=.55), as were the 30-day rates of death (1% vs 2%; P=.51), myocardial infarction (1% vs 1%; P=.90), target-vessel revascularization (0% vs 0%; P>.99), and stroke (0% vs 0%; P=.59). Angiographic complication, stent thrombosis, and major bleeding complication rates were similarly low in both groups.
Both heparin and bivalirudin were safe and effective antithrombotic agents for patients who underwent orbital atherectomy. A randomized trial is needed to determine the antithrombotic agent of choice for orbital atherectomy.
我们比较了肝素和比伐卢定在接受眼眶旋磨术治疗严重钙化冠状动脉病变患者中的血管造影和临床结果。
严重钙化冠状动脉病变与缺血性并发症增加相关。眼眶旋磨术可改变钙化斑块，从而便于支架置入和支架扩张。眼眶旋磨术期间理想的抗血栓药物尚不清楚。既往研究报道，在经皮冠状动脉介入治疗期间，与肝素加糖蛋白IIb/IIa抑制剂相比，比伐卢定的出血率更低。
这项回顾性多中心分析纳入了458例连续的、患有严重钙化冠状动脉并接受眼眶旋磨术的真实世界患者。根据所使用的抗血栓药物对患者进行分层。主要安全终点是30天主要不良心脑血管事件发生率，定义为死亡、心肌梗死、靶血管血运重建和中风。
356/458例（77.2%）使用了肝素，102/458例（22.8%）使用了比伐卢定。肝素组和比伐卢定组的主要终点相似（2%对3%；P = 0.55），30天死亡率（1%对2%；P = 0.51）、心肌梗死发生率（1%对1%；P = 0.90）、靶血管血运重建率（0%对0%；P>0.99）和中风发生率（0%对0%；P = 0.59）也相似。两组的血管造影并发症、支架血栓形成和大出血并发症发生率同样较低。
对于接受眼眶旋磨术的患者，肝素和比伐卢定都是安全有效的抗血栓药物。需要进行一项随机试验来确定眼眶旋磨术的首选抗血栓药物。
