Document Detail


Bivalirudin for Primary Percutaneous Coronary Interventions: Outcome Assessment in the Ottawa STEMI Registry.
MedLine Citation:
PMID:  23149331     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: DATA FROM RANDOMIZED TRIALS HAS DEMONSTRATED THE SUPERIORITY OF BIVALIRUDIN TO GLYCOPROTEIN IIB/IIIA INHIBITORS PLUS HEPARIN IN PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION. REAL-WORLD PERFORMANCE OF BIVALIRUDIN IN PRIMARY PERCUTANEOUS CORONARY INTERVENTION AND THE BENEFIT OF BIVALIRUDIN OVER HEPARIN REMAIN UNKNOWN IN AN ERA OF ROUTINE DUAL ANTIPLATELET THERAPY.METHODS AND RESULTS: FROM JULY 2004 TO DECEMBER 2010, 2317 CONSECUTIVE PATIENTS WERE INDEXED IN THE UNIVERSITY OF OTTAWA HEART INSTITUTE ST-ELEVATION MYOCARDIAL INFARCTION REGISTRY. DURING THIS PERIOD 748 PATIENTS RECEIVED BIVALIRUDIN, 699 PATIENTS RECEIVED GLYCOPROTEIN IIB/IIIA INHIBITORS, AND 676 PATIENTS RECEIVED UNFRACTIONATED HEPARIN ALONE. THE PRIMARY OUTCOME WAS THE RATE OF NONCORONARY ARTERY BYPASS GRAFT RELATED THROMBOLYSIS IN MYOCARDIAL INFARCTION MAJOR BLEEDING. BIVALIRUDIN SIGNIFICANTLY REDUCED THE PRIMARY OUTCOME COMPARED WITH HEPARIN PLUS GLYCOPROTEIN IIB/IIIA INHIBITORS (2.7% VERSUS 7.3%, ADJUSTED OR 2.96, 95% CI: 1.615.45, P0.001) AND THE COMPOSITE END POINT OF DEATH, STROKE, REINFARCTION AND MAJOR BLEED (OR 1.66, 95% CI: 1.122.45, P=0.01). COMPARED WITH HEPARIN ALONE, A REDUCTION IN MAJOR BLEEDS (OR 1.21, 95% CI: 0.602.44, P=0.59) OR THE COMPOSITE END POINT (1.05, 95% CI: 0.681.63, P=0.83) WITH BIVALIRUDIN COULD NOT BE DEMONSTRATED. NOTABLY, MAJOR BLEEDING WAS ASSOCIATED WITH A 5-FOLD INCREASE IN THE RISK OF MORTALITY BOTH IN-HOSPITAL (3.5% VERSUS 20.6%) AND OUT TO 180 DAYS (5.6% VERSUS 25.8%).CONCLUSIONS: Bivalirudin use compared with glycoprotein IIb/IIIa inhibitors plus heparin as an antithrombotic strategy in primary percutaneous coronary intervention results in less major bleeding in contemporary practice. A benefit of bivalirudin over heparin could not be established with this registry and requires additional investigations to either confirm or refute.
Authors:
Benjamin Hibbert; Andrea Macdougall; Marino Labinaz; Edward R O'Brien; Derek Y F So; Alexander Dick; Christopher Glover; Michael Froeschl; Jean-Francois Marquis; George A Wells; Melissa Blondeau; Michel R Le May
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-13
Journal Detail:
Title:  Circulation. Cardiovascular interventions     Volume:  -     ISSN:  1941-7632     ISO Abbreviation:  Circ Cardiovasc Interv     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101499602     Medline TA:  Circ Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
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