| Impact of bivalirudin on outcomes after percutaneous coronary revascularization with drug-eluting stents. | |
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MedLine Citation:
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PMID: 17892994 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The direct thrombin inhibitor bivalirudin has been found to be noninferior to heparin plus planned glycoprotein (GP) IIb/IIIa blockade in the prevention of acute ischemic end points and 1-year mortality after percutaneous coronary intervention (PCI) with bare metal stents. We investigated whether long-term outcomes after bivalirudin use remained comparable to heparin plus GP IIb/IIIa blockade in current clinical practice of drug-eluting stent use. METHODS: Using the 2004-2005 Cornell Angioplasty Registry, we studied 2504 consecutive patients undergoing urgent or elective PCI with periprocedural use of bivalirudin or heparin plus GP IIb/IIIa platelet inhibitors. Patients presenting with an acute ST-elevation myocardial infarction (MI) < or = 24 hours, thrombolytic therapy < or = 7 days, hemodynamic instability/shock, or renal insufficiency were excluded. RESULTS: Of the study cohort, 1340 patients (54%) received bivalirudin and 1164 patients (46%) received heparin plus GP IIb/IIIa blockade. The incidence of inhospital mortality (0.3% vs 0.2%, P = .692), MI (6.6% vs 8.1%, P = .191), and combined end point of death, stroke, emergent coronary artery bypass graft/PCI, and MI (6.9% vs 8.3%, P = .199) was similar in the bivalirudin and heparin plus GP IIb/IIIa inhibitor groups. There was a lower incidence of major (0.7% vs 1.9%, P = .012) and minor bleeding (9.6% vs 15.6%, P < .001) in the bivalirudin versus heparin plus GP IIb/IIIa inhibitor group. Mean clinical follow-up was 24.8 +/- 7.7 months. At follow-up, there were 87 (6.5%) deaths in the bivalirudin group versus 42 (3.6%) in the heparin plus GP IIb/IIIa inhibitor group (hazard ratio 1.87, 95% CI 1.30-2.71, P = .001). After a propensity score adjusted multivariate Cox analysis, bivalirudin use was associated with a nonsignificant trend toward increased long-term mortality (hazard ratio 1.45, 95% CI 0.98-2.16, P = .065). CONCLUSIONS: Compared with heparin plus GP IIb/IIIa inhibition, routine use of bivalirudin as the procedural anticoagulant in contemporary PCI with drug-eluting stents was associated with lower rates of inhospital complications and similar long-term all-cause mortality. |
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Authors:
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Dmitriy N Feldman; S Chiu Wong; Christopher L Gade; David S Gidseg; Geoffrey Bergman; Robert M Minutello |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2007-08-20 |
Journal Detail:
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Title: American heart journal Volume: 154 ISSN: 1097-6744 ISO Abbreviation: Am. Heart J. Publication Date: 2007 Oct |
Date Detail:
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Created Date: 2007-09-25 Completed Date: 2007-11-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: United States |
Other Details:
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Languages: eng Pagination: 695-701 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiology, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, NY 10021, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Angioplasty, Transluminal, Percutaneous Coronary* Anticoagulants / therapeutic use* Antithrombins / therapeutic use* Coronary Disease / mortality, therapy* Creatine Kinase, MB Form / blood Drug Therapy, Combination Female Heparin / therapeutic use* Hirudins Humans Intraoperative Complications / prevention & control Logistic Models Male Peptide Fragments / therapeutic use* Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors* Postoperative Hemorrhage / prevention & control Recombinant Proteins / therapeutic use Registries Retrospective Studies Stents* Treatment Outcome Troponin I / blood |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Antithrombins; 0/Hirudins; 0/Peptide Fragments; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 0/Recombinant Proteins; 0/Troponin I; 128270-60-0/bivalirudin; 9005-49-6/Heparin; EC 2.7.3.2/Creatine Kinase, MB Form |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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