| Bivalirudin in patients undergoing primary percutaneous coronary intervention for acute ST-elevation myocardial infarction: outcomes in a large real-world population. | |
| | |
MedLine Citation:
|
PMID: 23410540 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
|
Aims: Within a clinical trial population, direct thrombin inhibition using bivalirudin in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is associated with a reduction in mortality and major bleeding compared to heparin/glycoprotein IIb/IIIa receptor inhibition (GPI), but a higher incidence of acute stent thrombosis (ST), particularly in the absence of pre-procedural heparin. The safety and efficacy of bivalirudin in an all-comer, real-world primary PCI setting is unknown. Methods and results: 968 consecutive STEMI patients (mean age 63 years, 72% male, 42% anterior STEMI, 3.7% cardiogenic shock) undergoing primary PCI with bivalirudin as the recommended anticoagulation, and with heparin/GPI (abciximab) as an alternative, were prospectively followed. Bivalirudin was administered as a bolus, high-dose procedural infusion, and unlike the HORIZONS-AMI trial, as a low-dose infusion for four hours post-PCI. Additional heparin was not routinely given. Mortality, major adverse cardiovascular events (MACE), major bleeding and ST were assessed at 30 days. Initial anti-thrombotic therapy was bivalirudin in 885 patients (91%), of whom 123 (13.9%) received additional antithrombin therapy, and 114 (11.8%) "bail-out" GPI. Outcomes for bivalirudin-treated patients were; mortality 5.2%, MACE 7.5%, major bleeding 3.8%. The incidence of acute ST was 1.0%, including in the absence of additional heparin (1.2%). Most cases of acute ST (7/9) occurred in the first four hours post-PCI. There was no significant difference in outcomes between patients treated with bivalirudin versus heparin/GPI. Conclusions: Routine use of bivalirudin in a real-world primary PCI population was associated with good 30-day outcomes. Acute stent thrombosis was infrequent, even without additional heparin. A continued low-dose infusion of bivalirudin did not appear to offer protection against very early stent thrombosis. |
| | |
Authors:
|
Rhidian Shelton; Christos Eftychiou; Kathryn Somers; Alan Liu; Natalie Burton-Wood; Michelle Anderson; Loukia Makri; Jonathan Blaxill; James McLenachan; Stephen Wheatcroft; John Greenwood; Daniel Blackman |
Publication Detail:
|
Type: JOURNAL ARTICLE Date: 2013-2-18 |
Journal Detail:
|
Title: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology Volume: - ISSN: 1969-6213 ISO Abbreviation: EuroIntervention Publication Date: 2013 Feb |
Date Detail:
|
Created Date: 2013-2-15 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 101251040 Medline TA: EuroIntervention Country: - |
Other Details:
|
Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
|
Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Online peer support for mental health problems in the United States: 2004-2010.
Next Document: Prognostic Impact of the Presence and Absence of Angina on Mortality and Cardiovascular Outcomes in ...