PMID- 20197573
OWN - NLM
STAT- MEDLINE
DCOM- 20100610
LR  - 20161125
IS  - 1557-2501 (Electronic)
IS  - 1042-3931 (Linking)
VI  - 22
IP  - 3
DP  - 2010 Mar
TI  - Efficacy and safety of bivalirudin in patients with diabetes mellitus undergoing 
      percutaneous coronary intervention in current clinical practice.
PG  - 94-100
AB  - OBJECTIVES: This study sought to evaluate the short- and long-term efficacy and 
      safety of bivalirudin in diabetic patients undergoing percutaneous coronary 
      intervention (PCI) in contemporary clinical practice. BACKGROUND: Early trials of 
      platelet glycoprotein (GP) IIb/IIIa inhibitors have suggested a survival benefit 
      in diabetic patients undergoing PCI. More recently, randomized trials have 
      demonstrated that diabetic patients have similar protection from acute ischemic 
      events, while lowering the risk of bleeding complications, when treated with 
      bivalirudin monotherapy versus heparin plus GP IIb/IIIa blockade. However, the 
      impact of bivalirudin use on long-term outcomes in diabetic patients undergoing 
      PCI remains unclear. METHODS AND RESULTS: Using the Cornell Angioplasty Registry, 
      we studied 786 consecutive diabetic patients undergoing urgent or elective PCI 
      with a mean clinical follow up of 24.6 +/- 7.8 months. Of these, 428 patients 
      (54.5%) received bivalirudin monotherapy and 358 patients (45.5%) received 
      unfractionated heparin (UFH) plus GP IIb/IIIa inhibition. The incidence of 
      in-hospital death (0% vs. 0.3%; p = 0.46), post-procedural myocardial infarction 
      (MI) (4.7% vs. 7.0%; p = 0.169), and major adverse cardiovascular events (MACE) 
      (death, MI, stroke or urgent revascularization) (4.9% vs. 7.3%; p = 0.176) was 
      similar in the two groups, with less minor bleeding (9.6% vs. 14.5%; p = 0.035) 
      in the bivalirudin vs. UFH plus GP IIb/IIIa inhibitor group, respectively. By the 
      end of follow up, there were 38 (8.9%) deaths in the bivalirudin vs. 19 (5.3%) 
      deaths in the GP IIb/IIIa inhibitor arm (hazard ratio [HR] 1.8, 95% confidence 
      interval [CI] 1.0-3.1; p = 0.04). However, after a propensity score-adjusted 
      multivariate Cox regression analysis, there was no longer a significant 
      difference in long-term mortality between the two groups (HR 1.63; chi(2) = 2.61; 
      95% CI 0.90-2.94; p = 0.106). CONCLUSIONS: These findings indicate that in 
      diabetic patients, bivalirudin monotherapy results in similar protection from 
      acute ischemic events and long-term mortality, while lowering the risk of minor 
      bleeding in comparison to UFH plus GP IIb/IIIa inhibition.
FAU - Kim, Luke K
AU  - Kim LK
AD  - New York Presbyterian Hospital, Weill Cornell Medical College, Greenberg Division 
      of Cardiology, 520 East 70th Street, New York, NY 10021, USA.
FAU - Wong, S Chiu
AU  - Wong SC
FAU - Minutello, Robert M
AU  - Minutello RM
FAU - Bergman, Geoffrey
AU  - Bergman G
FAU - Feldman, Dmitriy N
AU  - Feldman DN
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - J Invasive Cardiol
JT  - The Journal of invasive cardiology
JID - 8917477
RN  - 0 (Anticoagulants)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
CIN - J Invasive Cardiol. 2010 Mar;22(3):101-2. PMID: 20197574
MH  - Aged
MH  - *Angioplasty, Balloon, Coronary
MH  - Anticoagulants/administration & dosage/adverse effects/therapeutic use
MH  - Coronary Artery Disease/*etiology/*therapy
MH  - Diabetes Complications/*complications
MH  - Female
MH  - Follow-Up Studies
MH  - Heparin/therapeutic use
MH  - Hirudins/administration & dosage/adverse effects
MH  - Humans
MH  - Infusions, Intravenous
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*prevention & control
MH  - Peptide Fragments/administration & dosage/adverse effects/*therapeutic use
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors
MH  - Recombinant Proteins/administration & dosage/adverse effects/therapeutic use
MH  - Registries
MH  - Retrospective Studies
MH  - Stroke/*prevention & control
MH  - Treatment Outcome
EDAT- 2010/03/04 06:00
MHDA- 2010/06/11 06:00
CRDT- 2010/03/04 06:00
PHST- 2010/03/04 06:00 [entrez]
PHST- 2010/03/04 06:00 [pubmed]
PHST- 2010/06/11 06:00 [medline]
PST - ppublish
SO  - J Invasive Cardiol. 2010 Mar;22(3):94-100.