Therapeutic efficacy of intracoronary infusion of bivalirudin in the treatment of no-reflow during primary percutaneous coronary intervention

Abstract:

Objective：To explore the therapeutic efficacy of intracoronary infusion of bivalirudin in the treatment of no-reflow or slow flow in coronary arteries during primary percutaneous coronary intervention（PPCI） in patients with acute ST-segment elevation myocardial infarction（STEMI）. Methods：A retrospective analysis was performed for the clinical data of 32 STEMI patients with no-reflow or slow flow during PPCI，who were admitted to the department of cardiology at Yongchuan Hospital of Chongqing Medical University from May 2017 to August 2018. All these patients were given intravenous bivalirudin anticoagulant during PPCI. According to the choice of drugs for intraoperative treatment of no-reflow in coronary artery，the patients were divided into two groups：bivalirudin group（bivalirudin 0.375 mg/kg，n=16） and control group（sodium nitroprusside 200 μg，n=16）. The thrombolysis in myocardial infarction（TIMI） blood flow grade of target vessel after treatment，the incidence of postoperative hemorrhage and cardiovascular events during hospitalization and major adverse cardiac events（MACE） 30 days after treatment were observed and compared between the two groups. Results：Compared with the control group，the bivalirudin group had a significantly increased proportion of TIMI grade 3 patients[12（75%） vs. 6 （37.5%），P<0.05]，and there was no significant difference between the two groups in postoperative cardiovascular events（P>0.05）. There were no postoperative bleeding and MACE 30 days after treatment in either group. Conclusion：Intracoronary infusion of bivalirdin，as a treatment with certain safety，can alleviate no-reflow or slow flow in patients with STEMI during primary PCI，and increase the forward flow of TIMI in target vessel after PCI.