PMID- 23746479
OWN - NLM
STAT- MEDLINE
DCOM- 20131031
LR  - 20161125
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 112
IP  - 6
DP  - 2013 Sep 15
TI  - Impact of bivalirudin and paclitaxel-eluting stents on outcomes in patients 
      undergoing primary percutaneous coronary intervention of the left anterior 
      descending artery.
PG  - 753-60
LID - S0002-9149(13)01116-8 [pii]
LID - 10.1016/j.amjcard.2013.05.006 [doi]
AB  - Patients with ST elevation myocardial infarction (STEMI) undergoing primary 
      percutaneous coronary intervention (PCI) of the left anterior descending artery 
      (LAD) are at increased risk for cardiovascular events compared with patients 
      undergoing non-LAD PCI. We assessed the impact of bivalirudin and 
      paclitaxel-eluting stenting (PES) in patients with STEMI who underwent LAD PCI. 
      In the HORIZONS-AMI trial, 1,445 patients had LAD PCI and 1,884 patients had 
      non-LAD PCI. The 3-year composite rates of death, reinfarction, stroke, or 
      ischemia-driven target vessel revascularization were significantly higher in 
      patients who underwent LAD PCI compared with non-LAD PCI (24.0% vs 20.6%, hazard 
      ratio [HR] 1.20, 95% confidence interval [CI] 1.04 to 1.39, p = 0.013), driven by 
      a statistically significant increase in cardiac death (5.4% vs 2.7%, HR 2.00, 95% 
      CI 1.40 to 2.86, p = 0.001). For patients who underwent LAD PCI, treatment with 
      bivalirudin resulted in significantly lower rates of cardiac death (3.8% vs 6.8%, 
      HR 0.55, 95% CI 0.34 to 0.89, p = 0.01), reinfarction (5.3% vs 9.5%, HR 0.55, 95% 
      CI 0.37 to 0.83, p = 0.004), and major bleeding events (7.3% vs 11.8%, HR 0.60, 
      95% CI 0.43 to 0.86, p = 0.004) compared with unfractionated heparin plus 
      glycoprotein IIb/IIIa inhibitor. Randomization to PES compared with bare-metal 
      stenting resulted in a significant lower rate of target vessel revascularization 
      (13.2% vs 19.8%, HR 0.64, 95% CI 0.47 to 0.86, p = 0.003) with no significant 
      differences in stent thrombosis, reinfarction, or death. In conclusion, in 
      patients with STEMI who underwent primary PCI of LAD, the use of bivalirudin was 
      associated with a reduction in mortality and bleeding rates at 3 years. PES 
      reduced revascularization rates in this population but did not have a significant 
      impact on mortality.
CI  - Copyright (c) 2013 Elsevier Inc. All rights reserved.
FAU - Wohrle, Jochen
AU  - Wohrle J
AD  - Department of Internal Medicine II, University of Ulm, Ulm, Germany. 
      jochen.woehrle@uniklinik-ulm.de
FAU - Brodie, Bruce
AU  - Brodie B
FAU - Witzenbichler, Bernhard
AU  - Witzenbichler B
FAU - Dudek, Dariusz
AU  - Dudek D
FAU - Kornowski, Ran
AU  - Kornowski R
FAU - Metzger, Chris
AU  - Metzger C
FAU - Grines, Cindy
AU  - Grines C
FAU - McAndrew, Thomas C
AU  - McAndrew TC
FAU - Parise, Helen
AU  - Parise H
FAU - Sergie, Ziad
AU  - Sergie Z
FAU - Mehran, Roxana
AU  - Mehran R
FAU - Stone, Gregg W
AU  - Stone GW
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20130606
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Antineoplastic Agents, Phytogenic)
RN  - 0 (Antithrombins)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - P88XT4IS4D (Paclitaxel)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Aged
MH  - Antineoplastic Agents, Phytogenic/pharmacology
MH  - Antithrombins/pharmacology
MH  - Coronary Angiography
MH  - Coronary Vessels/*surgery
MH  - *Drug-Eluting Stents
MH  - Electrocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Hirudins/*pharmacology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/diagnostic imaging/physiopathology/*surgery
MH  - Paclitaxel/*pharmacology
MH  - Peptide Fragments/*pharmacology
MH  - Percutaneous Coronary Intervention/*methods
MH  - Prospective Studies
MH  - Recombinant Proteins/pharmacology
MH  - Treatment Outcome
EDAT- 2013/06/12 06:00
MHDA- 2013/11/01 06:00
CRDT- 2013/06/11 06:00
PHST- 2013/02/17 00:00 [received]
PHST- 2013/05/02 00:00 [revised]
PHST- 2013/05/02 00:00 [accepted]
PHST- 2013/06/11 06:00 [entrez]
PHST- 2013/06/12 06:00 [pubmed]
PHST- 2013/11/01 06:00 [medline]
AID - S0002-9149(13)01116-8 [pii]
AID - 10.1016/j.amjcard.2013.05.006 [doi]
PST - ppublish
SO  - Am J Cardiol. 2013 Sep 15;112(6):753-60. doi: 10.1016/j.amjcard.2013.05.006. Epub 
      2013 Jun 6.