THE EFFICIENCY OF ANTI-COAGULANTS APPLIED DURING TRANSCUTANEOUS CORONARY INTERVENTIONS IN PATIENTS WITH ACUTE CORONARY SYNDROME WITHOUT ELEVATION OF ST SEGMENT


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Abstract

The purpose of study. To evaluate efficiency of different coagulants used under transcutaneous coronary interventions in patients with acute coronary syndrome without elevation of ST segment.The methods. The sampling of 346 patients was randomized in two groups. In the group I (n=155) transcutaneous coronary intervention was implemented using bivalirudin and in group II (n = 191) - using unfractionated heparin. The additional randomization of patients of group I: in subgroup A (n = 77) infusion of bivalirudin continued during four hours after intervention and in subgroup B (n = 78) infusion was discontinued in X-ray operating room. The criteria of inclusion: patients with acute coronary syndrome without elevation of ST segment with multi-vascular affection of coronary channel (risk on SYNTAX score = 23-32); high and medium degree of risk according GRACE scale; absence of re-vascularization of myocardium in anamnesis. The criteria of exclusion: patients with very high risk according GRACE scale; affection of left coronary artery trunk. The results. During period of hospitalization, total rate of intra- and post-operative cardiovascular complications had no reliable differences in two groups and amounted to 7.1% and 8.4% correspondingly (p = 0.6423). The serious bleedings (BARC 3 and 5) occurred reliably more frequently in patients of group II. Also, the groups had no differences in rate of development of acute thrombosis of stents. In subgroup A reliably less frequently occurred serious cardiovascular complications as compared with patients of subgroup B (1,3% и 13% correspondingly; р = 0,001). At that, rate of bleeding reliably had no differences. At trans-radial access, in patients of group I rate of bleeding and cardiovascular complications amounted to 0% and 2.9% and at trans-femoral access these indices were reliably higher - 3,3% и 10% correspondingly (р < 0,001). In group II a similar tendency is noted: at trans-radial access these indices amounted to 6% and 4.6% and at trans-femoral - 33.7% and 11.9% correspondingly (р<0,001). When compared with these indices is was established that independently of selected arterial access, cordial occurrences reliably had no differences in group of bivalirudin and heparin. At that, bleeding were reliably more often detected in group of heparin ((р < 0,001). The remote results of treatment (average term was 12±0,14 months) were observed in 192 patients and out of them 91 patients were of group I and 101 patients of group II. The total rate of cardiovascular complications was reliably lower in group I in comparison with group II and amounted to 2.2% and 6% correspondingly (р = 0,0312).The conclusion. The application of such direct inhibitor of thrombin as bivalirudin during transcutaneous coronary intervention in patients with acute coronary syndrome without elevation of ST segment contributes to decreasing of risk of hemorrhagic complications during the nearest post-operative period and differs by its positive effect on remote prognosis in such patients. The application of transcutaneous coronary intervention by radial access and also prolongation of infusion of bivalirudin during 4 hours after transcutaneous coronary intervention are additional factors of benevolent prognosis under endovascular treatment of acute coronary syndrome without elevation of ST segment.

About the authors

T. P Chernigina

The peoples' friendship university of Russia; The central municipal clinical hospital

117198, Moscow, Russian Federation; 143964, Reutov, Russian Federation

R. S Goloshchapov-Aksenov

The peoples' friendship university of Russia; The central municipal clinical hospital

117198, Moscow, Russian Federation; 143964, Reutov, Russian Federation

Daniil A. Maksimkin

The peoples' friendship university of Russia; The N.A. Semashko central clinical hospital №2 of the Russian Railways

Email: danmed@bk.ru
candidate of medical sciences, associate professor of the chair of hospital surgery with the course of children surgery of the medical institute the peoples' friendship university of Russia, 117198, Moscow, Russian Federation 117198, Moscow, Russian Federation; 107150, Moscow, Russian Federation

N. V Sturov

The peoples' friendship university of Russia

117198, Moscow, Russian Federation

Z. Kh Shugushev

The peoples' friendship university of Russia; The N.A. Semashko central clinical hospital №2 of the Russian Railways

117198, Moscow, Russian Federation; 107150, Moscow, Russian Federation

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