PMID- 23074143
OWN - NLM
STAT- MEDLINE
DCOM- 20140418
LR  - 20181202
IS  - 1522-726X (Electronic)
IS  - 1522-1946 (Linking)
VI  - 82
IP  - 3
DP  - 2013 Sep 1
TI  - Bleeding outcomes after routine transradial primary angioplasty for acute 
      myocardial infarction using eptifibatide and unfractionated heparin: a 
      single-center experience following the HORIZONS-AMI trial.
PG  - E138-47
LID - 10.1002/ccd.24703 [doi]
AB  - OBJECTIVES: We sought to (1) determine the bleeding rates after primary 
      percutaneous coronary intervention (PPCI) in our institution, where the default 
      strategy has been transradial (TR) access in combination with unfractionated 
      heparin (UFH) plus eptifibatide, and (2) compare these with the outcomes of 
      patients treated with bivalirudin in HORIZONS-AMI. BACKGROUND: HORIZONS-AMI 
      demonstrated that in PPCI undertaken via the transfemoral route, routine use of 
      bivalirudin was associated with lower bleeding rates and improved mortality 
      compared to routine use of UFH plus glycoprotein IIb/IIIa inhibitor (GPI). 
      METHODS: This was a single-center prospective registry of consecutive patients 
      undergoing PPCI from January 2009 to August 2011 at the Queen Elizabeth Hospital 
      Birmingham, UK. Thirty-day major bleeding was defined as per the HORIZONS-AMI 
      criteria and also according to TIMI and GUSTO scales. RESULTS: Of the 432 
      consecutive patients, 350 fulfilled entry criteria for HORIZONS-AMI. In contrast 
      with HORIZONS-AMI, these subjects were older (62.5 +/- 13.7 yr vs. 59.8 +/- 11.1 yr, 
      P < 0.05) with a higher rate of cardiogenic shock (6.3% vs. 0.8%, P < 0.0001). 
      Despite this higher risk population, the rate of major bleeding was favorable 
      (3.7% [95% CI: 2.0-6.3%] vs. 4.9% [4.0-6.1%], P = 0.32). Similarly, TIMI major 
      bleeding (2.0% [0.8-4.1%] vs. 3.1% [2.3-3.4%], P = 0.10) and GUSTO severe or 
      life-threatening bleeding (0.6% [0.1-2.5%] vs. 0.4% [0.2-0.9%], P = 0.75) were 
      comparable. CONCLUSIONS: Routine TR access for PPCI using UFH plus GPI is 
      associated with a low 30-day rate of major bleeding equivalent to the bivalirudin 
      arm of HORIZONS-AMI. Default transradial access for PPCI permits routine use of a 
      GPI without the penalty of high bleeding rates.
CI  - Copyright (c) 2013 Wiley Periodicals, Inc.
FAU - Moody, William E
AU  - Moody WE
AD  - Department of Cardiovascular Medicine, Nuffield House, Queen Elizabeth Hospital 
      Birmingham, Edgbaston, Birmingham, B15 2TH, United Kingdom.
FAU - Chue, Colin D
AU  - Chue CD
FAU - Ludman, Peter F
AU  - Ludman PF
FAU - Chan, Yik-Ki C
AU  - Chan YK
FAU - Narayan, Gautam
AU  - Narayan G
FAU - Millington, Jenna M
AU  - Millington JM
FAU - Townend, Jonathan N
AU  - Townend JN
FAU - Doshi, Sagar N
AU  - Doshi SN
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20130408
PL  - United States
TA  - Catheter Cardiovasc Interv
JT  - Catheterization and cardiovascular interventions : official journal of the 
      Society for Cardiac Angiography & Interventions
JID - 100884139
RN  - 0 (Anticoagulants)
RN  - 0 (Antithrombins)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Peptides)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - NA8320J834 (Eptifibatide)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Aged
MH  - Angioplasty, Balloon, Coronary/adverse effects/*methods
MH  - Anticoagulants/*adverse effects
MH  - Antithrombins/adverse effects
MH  - *Cardiac Catheterization/adverse effects
MH  - Coronary Thrombosis/etiology/prevention & control
MH  - England
MH  - Eptifibatide
MH  - Female
MH  - Fibrinolytic Agents/*adverse effects
MH  - Hemorrhage/*chemically induced/diagnosis/prevention & control
MH  - Heparin/*adverse effects
MH  - Hirudins/adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/complications/diagnosis/*therapy
MH  - Peptide Fragments/adverse effects
MH  - Peptides/*adverse effects
MH  - Platelet Aggregation Inhibitors/*adverse effects
MH  - Prospective Studies
MH  - *Radial Artery
MH  - Recombinant Proteins/adverse effects
MH  - Registries
MH  - Risk Factors
MH  - Shock, Cardiogenic/etiology/therapy
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - ST-elevation myocardial infarction
OT  - access
OT  - bivalirudin
OT  - bleeding
OT  - eptifibatide
EDAT- 2012/10/18 06:00
MHDA- 2014/04/20 06:00
CRDT- 2012/10/18 06:00
PHST- 2012/09/11 00:00 [received]
PHST- 2012/10/07 00:00 [accepted]
PHST- 2012/10/18 06:00 [entrez]
PHST- 2012/10/18 06:00 [pubmed]
PHST- 2014/04/20 06:00 [medline]
AID - 10.1002/ccd.24703 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2013 Sep 1;82(3):E138-47. doi: 10.1002/ccd.24703. 
      Epub 2013 Apr 8.