Document Detail


Prehospital treatment of patients with acute myocardial infarction with bivalirudin.
MedLine Citation:
PMID:  20971597     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Patients with acute myocardial infarction are at high risk of dying within the first hours after onset of coronary ischemia. Therefore, pharmacological intervention should be started in the prehospital setting. This study investigates the effect of the prehospital administration of bivalirudin on short-term morbidity and mortality compared to heparin plus abciximab in patients with ST-segment-elevation myocardial infarction (STEMI).
METHODS: One hundred ninety-eight patients with STEMI treated with bivalirudin in the prehospital setting were prospectively collected. Coronary angiography was performed to identify the infarct-related artery. In case of a percutaneous coronary intervention, bivalirudin was given according to the guidelines. The historic control group consisted of 171 consecutive patients from the same myocardial infarction network treated with unfractioned heparin and abciximab administration before the admission to the emergency department of the percutaneous coronary intervention center. The primary outcome parameter was the incidence of major adverse cardiac events (recurrent myocardial infarction, stroke, death, target vessel revascularization for ischemia) within 30 days after the primary event.
RESULTS: The overall rate of major adverse cardiac events was significantly lower in the bivalirudin group compared to the abciximab group (7.6% vs 14.6%; P = .04). The number of major bleedings was significantly higher in the abciximab group compared to the bivalirudin group (11.8% vs 3.8%; P = .03).
CONCLUSIONS: The use of bivalirudin in the prehospital setting leads to a reduced rate of major cardiovascular events compared to a standard treatment with abciximab plus heparin. Bivalirudin is a reasonable choice of treatment in the prehospital setting for patients with STEMI.
Authors:
Michael M Hirschl; Harald Mayr; Friedrich Erhart; Walter Brunner; Friedrich Steger; Martin Gattermeier; Franz Pfeffel
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-10-23
Journal Detail:
Title:  The American journal of emergency medicine     Volume:  30     ISSN:  1532-8171     ISO Abbreviation:  Am J Emerg Med     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2011-11-23     Completed Date:  2012-01-23     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  8309942     Medline TA:  Am J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  12-7     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Affiliation:
3rd Medical Department, Landesklinikum St. Pölten, A-3100 St. Pölten, Austria. michael.hirschl@zwettl.lknoe.at
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty / methods
Antibodies, Monoclonal / administration & dosage,  adverse effects,  therapeutic use
Anticoagulants / administration & dosage,  adverse effects,  therapeutic use
Antithrombins / administration & dosage,  adverse effects,  therapeutic use*
Cardiac Catheterization
Drug Therapy, Combination
Emergency Medical Services / methods*
Female
Hemorrhage / prevention & control
Heparin / adverse effects,  therapeutic use
Hirudins / administration & dosage,  adverse effects
Humans
Immunoglobulin Fab Fragments / administration & dosage,  adverse effects,  therapeutic use
Male
Middle Aged
Myocardial Infarction / complications,  drug therapy*,  mortality
Peptide Fragments / administration & dosage,  adverse effects,  therapeutic use*
Preoperative Care / adverse effects,  methods
Prospective Studies
Recombinant Proteins / administration & dosage,  adverse effects,  therapeutic use
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Anticoagulants; 0/Antithrombins; 0/Hirudins; 0/Immunoglobulin Fab Fragments; 0/Peptide Fragments; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 9005-49-6/Heparin; X85G7936GV/abciximab

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