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  • Bikdeli, BehnoodHarvard Med Sch, Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA USA.;Harvard Med Sch, Brigham & Womens Hosp, Thrombosis Res Grp, Boston, MA USA.;Yale New Haven Hosp, Yale Ctr Outcomes Res & Evaluat, New Haven, CT USA.,Harvard Medical School (author)

Bivalirudin Versus Heparin During PCI in NSTEMI : Individual Patient Data Meta-Analysis of Large Randomized Trials

  • Article/chapterEnglish2023

Publisher, publication year, extent ...

  • American Heart Association,2023
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:uu-522784
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-522784URI
  • https://doi.org/10.1161/CIRCULATIONAHA.123.063946DOI
  • https://lup.lub.lu.se/record/a6d052b0-0b42-4654-ad90-622cf181cc8dURI
  • https://gup.ub.gu.se/publication/329175URI

Supplementary language notes

  • Language:English
  • Summary in:English

Part of subdatabase

Classification

  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • BACKGROUND: The benefit:risk profile of bivalirudin versus heparin anticoagulation in patients with non-ST-segment-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) is uncertain. Study-level meta-analyses lack granularity to provide conclusive answers. We sought to compare the outcomes of bivalirudin and heparin in patients with non-ST-segment-elevation myocardial infarction undergoing PCI.METHODS: We performed an individual patient data meta-analysis of patients with non-ST-segment-elevation myocardial infarction in all 5 trials that randomized >= 1000 patients with any myocardial infarction undergoing PCI to bivalirudin versus heparin (MATRIX [Minimizing Adverse Hemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox], VALIDATE-SWEDEHEART [Bivalirudin Versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies Registry Trial], ISAR-REACT 4 [Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 4], ACUITY [Acute Catheterization and Urgent Intervention Triage Strategy], and BRIGHT [Bivalirudin in Acute Myocardial Infarction vs Heparin and GPI Plus Heparin Trial]). The primary effectiveness and safety end points were 30-day all-cause mortality and serious bleeding.RESULTS: A total of 12155 patients were randomized: 6040 to bivalirudin (52.3% with a post-PCI bivalirudin infusion), and 6115 to heparin (53.2% with planned glycoprotein IIb/IIIa inhibitor use). Thirty-day mortality was not significantly different between bivalirudin and heparin (1.2% versus 1.1%; adjusted odds ratio, 1.24 [95% CI, 0.86-1.79]; P=0.25). Cardiac mortality, reinfarction, and stent thrombosis rates were also not significantly different. Bivalirudin reduced serious bleeding (both access site-related and non-access site-related) compared with heparin (3.3% versus 5.5%; adjusted odds ratio, 0.59; 95% CI, 0.48-0.72; P<0.0001). Outcomes were consistent regardless of use of a post-PCI bivalirudin infusion or routine lycoprotein IIb/IIIa inhibitor use with heparin and during 1-year follow-up.CONCLUSIONS: In patients with non-ST-segment-elevation myocardial infarction undergoing PCI, procedural anticoagulation with bivalirudin and heparin did not result in significantly different rates of mortality or ischemic events, including stent thrombosis and reinfarction. Bivalirudin reduced serious bleeding compared with heparin arising both from the access site and nonaccess sites.

Subject headings and genre

Added entries (persons, corporate bodies, meetings, titles ...)

  • Erlinge, DavidLund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Molekylär kardiologi,Forskargrupper vid Lunds universitet,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Molecular Cardiology,Lund University Research Groups(Swepub:lu)kard-der (author)
  • Valgimigli, MarcoUniv Bern, Univ Hosp Bern, Bern, Switzerland.,Bern University Hospital (author)
  • Kastrati, AdnanTech Univ, Deutsch Herzzentrum Munchen, Munich, Germany.;German Ctr Cardiovasc Res, Partner Site Munich Heart Alliance, Munich, Germany.,German Centre for Cardiovascular Research,Technical University of Munich (author)
  • Han, YalingGen Hosp Northern Theater Command, Shenyang, Peoples R China.,Shenyang General Hospital of PLA (author)
  • Steg, Philippe GabrielUniv Paris Cite, French Alliance Cardiovasc Trials, Inst Natl Sante & Rech Med, Assistance Publ Hop Paris,U1148, Paris, France.;Imperial Coll, Royal Brompton Hosp, London, England.,Université Paris Cité,Royal Brompton Hospital (author)
  • Stables, Rod H.Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England.;Univ Liverpool, Liverpool, Merseyside, England.,University of Liverpool,Liverpool Heart and Chest Hospital (author)
  • Mehran, RoxanaIcahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY USA.;Cardiovasc Res Fdn, New York, NY USA.,Cardiovascular Research Foundation, New York,Icahn School of Medicine at Mount Sinai (author)
  • James, Stefan,1964-Uppsala University,Uppsala universitet,Kardiologi(Swepub:uu)stjam367 (author)
  • Frigoli, EnricoUniv Bern, Univ Hosp Bern, Bern, Switzerland.,Bern University Hospital (author)
  • Goldstein, PatrickLille Univ Hosp, Lille, France.,Lille University Hospital (author)
  • Li, YiGen Hosp Northern Theater Command, Shenyang, Peoples R China.,Shenyang General Hospital of PLA (author)
  • Shahzad, AdeelLiverpool Heart & Chest Hosp, Liverpool, Merseyside, England.;Univ Liverpool, Liverpool, Merseyside, England.,University of Liverpool,Liverpool Heart and Chest Hospital (author)
  • Schuepke, StefanieTech Univ, Deutsch Herzzentrum Munchen, Munich, Germany.;German Ctr Cardiovasc Res, Partner Site Munich Heart Alliance, Munich, Germany.,Technical University of Munich,German Centre for Cardiovascular Research (author)
  • Mehdipoor, GhazalehMontefiore Med Ctr, Div Nucl Med, Dept Radiol, Bronx, NY USA.,Montefiore Medical Center (author)
  • Chen, ShmuelNew York Presbyterian Hosp, Weill Cornell Cornell Med Ctr, New York, NY USA.,Weill Cornell Medical Center (author)
  • Redfors, BjörnGothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine(Swepub:gu)xredbj (author)
  • Crowley, AaronGenesis Res, Hoboken, NJ USA. (author)
  • Zhou, ZhipengCardiovasc Res Fdn, New York, NY USA.,Cardiovascular Research Foundation, New York (author)
  • Stone, Gregg W.Icahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY USA.,Icahn School of Medicine at Mount Sinai (author)
  • Harvard Med Sch, Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA USA.;Harvard Med Sch, Brigham & Womens Hosp, Thrombosis Res Grp, Boston, MA USA.;Yale New Haven Hosp, Yale Ctr Outcomes Res & Evaluat, New Haven, CT USA.Harvard Medical School (creator_code:org_t)

Related titles

  • In:Circulation: American Heart Association148:16, s. 1207-12190009-73221524-4539

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