关键词: 心肌梗死, 比伐芦定, 血管成形术, 气囊, 冠状动脉, 无复流现象, 预后, 影响因素

Abstract: Background　Coronary no-reflow is an important factor associated with the effect of emergency PCI in patients with acute ST-segment elevation myocardial infarction （STEMI），which is also a prognostic factor as it increases the risk of death.So it is essential to identify effective drug treatment to improve the effect of PCI and reduce the possibility of developing coronary no-reflow.Objective　To perform a comparative analysis of intracoronary with intravenous administration of bivalirudin and intravenous administration of bivalirudin in patients with acute STEMI in terms of safety and effects on no-reflow during PCI and short-term outcome.Methods　Participants were 110 inpatients who were diagnosed with acute STEMI and underwent PCI within 12 hours of symptom onset in Xinjiang Medical University Affiliated TCM Hospital from June 2017 to January 2019.They were evenly randomized into observation group with intracoronary with intravenous administration of bivalirudin，and control group with intravenous administration of bivalirudin.Intraoperative and postoperative observation indices（number of diseased coronary artery vessels，infarct-related artery（IRA），preoperative TIMI flow grade of target vessel，Gensini score，door-to-balloon time，number of thrombus aspiration cases，number of implanted stents，rate of poststenotic dilation，rate of postoperatively using ACEIs or ARBs，rate of postoperatively usingβ-blockers），therapeutic evaluation indices〔corrected TIMI frame count（CTFC） of the IRA measured immediately after stent implantation，and rate of coronary no-reflow during PCI，degree of ST-segment depression within four hours after PCI，serum CK-MB and LVEF at 24 hours after PCI〕，and major adverse cardiovascular events（MACE） within 30 days after PCI were compared between the two groups.Multivariate logistic regression analysis was used to investigate the effect of intracoronary and intravenous bivalirudin bolus administration during PCI on some therapeutic indices.Results　There were no significant differences in intraoperative and postoperative observation indices between the two groups（P>0.05）.The CTFC of the IRA measured immediately after stent implantation，rate of coronary no-reflow and degree of ST-segment depression within four hours after PCI differed significantly between the two groups（P<0.05）.Multivariate Logistic regression analysis showed that intracoronary and intravenous bivalirudin bolus administration during PCI was associated with reduced number of CTFC of the IRA measured immediately after stent implantation 〔OR=0.423，95%CI（0.321，0.656），P=0.005〕，reduced possibility of developing coronary no-reflow 〔OR=0.431，95%CI（0.262，0.812），P=0.002〕，and greater degree of ST-segment depression within four hours after PCI〔OR=1.532，95%CI（0.627，2.517），P=0.003〕.Conclusion　The results of this study demonstrate that intracoronary and intravenous bivalirudin administration during PCI could reduce the incidence of coronary no-reflow and the risks of acute heart failure and all-cause death，and improve short-term clinical outcome in acute STEMI patients with good safety.

Key words: Myocardial infarction；Bivalirudin；Angioplasty, Balloon, Coronary；No-Reflow Phenomenon；Prognosis；Root cause analysis