PMID- 23350949
OWN - NLM
STAT- MEDLINE
DCOM- 20130809
LR  - 20161125
IS  - 1473-4877 (Electronic)
IS  - 0300-7995 (Linking)
VI  - 29
IP  - 3
DP  - 2013 Mar
TI  - How to reduce mortality in ST-elevation myocardial infarction patients treated 
      with primary percutaneous coronary interventions: cut the bleeding.
PG  - 189-94
LID - 10.1185/03007995.2013.770389 [doi]
AB  - BACKGROUND: In-hospital mortality for ST-elevation myocardial infarction (STEMI) 
      has declined thanks to a greater use of primary percutaneous coronary 
      interventions (PCI) associated with more effective antiplatelet and anticoagulant 
      drugs. In this regard, bivalirudin has been shown to decrease total and cardiac 
      mortality as compared to unfractionated heparin (UFH). OBJECTIVE: The primary 
      purpose of this analysis is to evaluate the hypothesis that the reduction of 
      in-hospital bleeding is the most plausible explanation for the improved survival 
      of STEMI patients treated with bivalirudin during primary PCI. The secondary 
      objective is to reconsider the prognostic significance of the radial access alone 
      or in association with bivalirudin on the basis of the published data. METHODS: 
      We have done a comprehensive evaluation of the main and related publications of 
      the HORIZONS-AMI trial in addition to an extensive research by Medline of 
      randomized trials evaluating the prognostic impact of radial access as compared 
      with the femoral one in primary PCI. RESULTS: In the HORIZONS-AMI trial 
      bivalirudin resulted in significantly lower rates of the 30 day primary endpoint 
      (defined as major adverse ischemic outcomes plus major bleeding) over UFH plus 
      GPI, largely due to the significantly lower rate of the protocol-defined major 
      bleeding. All-cause and cardiac mortality were also reduced in the bivalirudin 
      arm at 3 year follow-up. Recent studies have also shown that the use of the 
      radial instead of the femoral approach for primary PCI is associated with reduced 
      bleeding as well as reduced mortality. CONCLUSIONS: Our research suggests that 
      decreasing bleeding by either a pharmacologic strategy (use of bivalirudin) or a 
      technical approach (the transradial access) improves survival in STEMI patients 
      undergoing primary PCI. The validity of this hypothesis should be confirmed by 
      specific randomized trials.
FAU - De Servi, Stefano
AU  - De Servi S
AD  - Department of Cardiovascular Diseases, Ospedale Civile di Legnano, Milan, Italy. 
      stefano.deservi@ao-legnano.it
FAU - Mariani, Giuseppe
AU  - Mariani G
FAU - Mariani, Matteo
AU  - Mariani M
FAU - D'Urbano, Maurizio
AU  - D'Urbano M
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20130131
PL  - England
TA  - Curr Med Res Opin
JT  - Current medical research and opinion
JID - 0351014
RN  - 0 (Anticoagulants)
RN  - 0 (Antithrombins)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Anticoagulants/therapeutic use
MH  - Antithrombins/therapeutic use
MH  - Hemorrhage/*drug therapy/mortality
MH  - Heparin/therapeutic use
MH  - Hirudins
MH  - Humans
MH  - Myocardial Infarction/*drug therapy/*mortality
MH  - Peptide Fragments/*therapeutic use
MH  - *Percutaneous Coronary Intervention
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Recombinant Proteins/therapeutic use
EDAT- 2013/01/29 06:00
MHDA- 2013/08/10 06:00
CRDT- 2013/01/29 06:00
PHST- 2013/01/29 06:00 [entrez]
PHST- 2013/01/29 06:00 [pubmed]
PHST- 2013/08/10 06:00 [medline]
AID - 10.1185/03007995.2013.770389 [doi]
PST - ppublish
SO  - Curr Med Res Opin. 2013 Mar;29(3):189-94. doi: 10.1185/03007995.2013.770389. Epub 
      2013 Jan 31.