Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2024; 12(22): 4890-4896
Published online Aug 6, 2024. doi: 10.12998/wjcc.v12.i22.4890
Effect of bivalirudin on myocardial microcirculation and adverse events after interventional therapy in older patients with acute coronary syndrome
Ya-Kun Du, Li-Jun Cui, Hong-Bo Gao
Ya-Kun Du, Li-Jun Cui, Hong-Bo Gao, Cardiovascular Department, Hanzhong People’s Hospital, Hanzhong 723000, Shaanxi Province, China
Author contributions: Du YK, Cui LJ, and Gao HB designed the research study; Du YK, Cui LJ, and Gao HB performed the primary literature review and data extraction; Du YK and Cui LJ analyzed the data and wrote the manuscript; Du YK, Cui LJ, and Gao HB were responsible for revising the manuscript for intellectual content; All authors have read and approved the final version.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Hanzhong People’s Hospital.
Informed consent statement: All study participants or their legal guardians provided written informed consent for personal and medical data collection before study enrolment.
Conflict-of-interest statement: The authors declare they have nothing to disclose.
Data sharing statement: No other data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Bo Gao, MMed, Attending Doctor, Cardiovascular Department, Hanzhong People’s Hospital, No. 251 North Tuanjie Street, Hantai District, Hanzhong 723000, Shaanxi Province, China. g816176939331@163.com
Received: April 10, 2024
Revised: May 6, 2024
Accepted: June 5, 2024
Published online: August 6, 2024
Processing time: 82 Days and 20.9 Hours
Abstract
BACKGROUND

Bivalirudin, a direct thrombin inhibitor, is used in anticoagulation therapies as a substitute for heparin, especially during cardiovascular procedures such as percutaneous coronary intervention.

AIM

To explore the effect of bivalirudin on myocardial microcirculation following an intervention and its influence on adverse cardiac events in elderly patients with acute coronary syndrome (ACS).

METHODS

In total, 165 patients diagnosed with acute myocardial at our hospital between June 2020 and June 2022 were enrolled in this study. From June 2020 to June 2022, elderly patients with ACS with complete data were selected and treated with interventional therapy. The study cohort was randomly divided into a study group (n = 80, administered bivalirudin) and a control group (n = 85, administered unfractionated heparin). Over a 6-mo follow-up period, differences in emergency processing times, including coronary intervention, cardiac function indicators, occurrence of cardiovascular events, and recurrence rates, were analyzed.

RESULTS

Significant differences were observed between the study cohorts, with the observation group showing shorter emergency process times across all stages: Emergency classification; diagnostic testing; implementation of coronary intervention; and conclusion of emergency treatment (P < 0.05). Furthermore, the left ventricular ejection fraction in the observation group was significantly higher (P < 0.05), and the creatine kinase-MB and New York Heart Association scores were notably lower than those in the control group (P < 0.05).

CONCLUSION

In elderly patients receiving interventional therapy for ACS, bivalirudin administration led to increased activated clotting time achievement rates, enhanced myocardial reperfusion, and reduced incidence of bleeding complications and adverse cardiac events.

Keywords: Bivalirudin, Heparin, Acute coronary syndrome, Corrected thrombolysis in myocardial infarction flow frame count, Thrombolysis in myocardial infarction, myocardial perfusion classification

Core Tip: Effective anticoagulation management is essential for older patients with acute coronary syndrome, especially in those with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. Bivalirudin may be an innovative drug for achieving this goal.