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This study was designed to determine the safety and efficacy of different antiplatelet regimens in acute coronary syndrome(ACS) patients undergoing elective percutaneous coronary intervention(PCI).
Patients hospitalized in the Second hospital of Hebei Medical University for ACS-PCI between December, 2014 and June, 2016, and prescribed bivalirudin or unfractionated heparin(UFH) in intraoperative and ticagrelor or clopidogrel were selected. A total of 280 ACS-PCI patients were recruited. Patients were categorized into four groups: clopidogrel and bivalirudin (C1); ticagrelor and bivalirudin(T1); clopidogrel and UFH(C2); ticagrelor and UFH(T2); The primary objective compared 30-day major adverse cardiovascular events and bleeding. Secondary objective included independent predictors of MACE.
The 30-day MACE were not significantly different in four groups(χ2=2.214, P=0.529)nor were the events of major bleeding(χ2=2.75, P=0.432). But,the Cumulative rates(Kaplan-Meier) curve of the MACE events showed the T1group has an advantage over the other three groups. There was statistical significance in little bleeding events(χ2=8.400,P=0.038). Cox regression analysis showed that diabetes mellitus(OR=6.96, CI 95% 1.92-25.26)and hyperlipidemia (OR=6.56, CI 95% 1.82-23.55)and smoking(OR=3.77, CI 95% 1.09-12.98) were independent risk factors for the occurrence of MACE.
Therefore, bivalirudin combined with ticagrelor may reduce the rate of the adverse cardiovascular events in ACS patients following elective PCI. Bivalirudin could increase the risk of little bleeding events but does not increase the risk of major bleeding. And diabetes mellitus, hyperlipidemia and smoking were independent risk factors for the occurrence of MACE.