PMID- 27838271
OWN - NLM
STAT- MEDLINE
DCOM- 20171025
LR  - 20181014
IS  - 1876-7605 (Electronic)
IS  - 1936-8798 (Linking)
VI  - 9
IP  - 23
DP  - 2016 Dec 12
TI  - Use and Effectiveness of Bivalirudin Versus Unfractionated Heparin for 
      Percutaneous Coronary Intervention Among Patients With ST-Segment Elevation 
      Myocardial Infarction in the United States.
PG  - 2376-2386
LID - S1936-8798(16)31546-1 [pii]
LID - 10.1016/j.jcin.2016.09.020 [doi]
AB  - OBJECTIVES: The purpose of this study was to describe temporal trends and 
      determine the comparative effectiveness of bivalirudin versus unfractionated 
      heparin (UFH) during percutaneous coronary intervention (PCI) for ST-segment 
      elevation myocardial infarction (STEMI). BACKGROUND: Several clinical trials have 
      compared the safety and effectiveness of bivalirudin versus UFH during PCI for 
      STEMI, but results have been conflicting. METHODS: Trends in anticoagulant use 
      were examined among 513,775 PCIs for STEMI from July 2009 through December 2014 
      within the National Cardiovascular Data Registry CathPCI Registry. We conducted 
      an instrumental variable analysis comparing bivalirudin with UFH, using operator 
      preference for bivalirudin as the instrument. We used a test of mediation to 
      determine the extent to which differences in outcomes between anticoagulants were 
      due to differences in use of glycoprotein IIb/IIIa inhibitors (GPI). Primary 
      outcomes were in-hospital bleeding and mortality. RESULTS: Bivalirudin use 
      increased from 2009 through 2013, followed by a new decline. GPIs were used in 
      74.7% of UFH PCIs versus 26.5% of bivalirudin PCIs. In unadjusted analyses, 
      bivalirudin was associated with decreased bleeding (risk difference [RD]: -4.2%; 
      p < 0.001) and mortality (RD: -0.84%; p < 0.001). After instrumental variable 
      analyses, bivalirudin remained associated with less bleeding (RD: -3.75%; p < 
      0.001), but not mortality (RD: -0.10%; p = 0.280). The higher rate of GPI use 
      with UFH was responsible for more than one-half of bivalrudin's bleeding 
      reduction (GPI-adjusted RD: -1.57%; p < 0.001). Bleeding reductions were 
      negligible for transradial PCI (RD: -0.11%; p = 0.842). CONCLUSIONS: The use of 
      bivalirudin during STEMI has decreased. Bivalirudin was associated with reduced 
      bleeding and no mortality difference. The bleeding reduction with bivalirudin was 
      largely explained by the greater use of GPIs with UFH.
CI  - Copyright A(c) 2016 American College of Cardiology Foundation. Published by 
      Elsevier Inc. All rights reserved.
FAU - Secemsky, Eric A
AU  - Secemsky EA
AD  - Division of Cardiology, Department of Medicine, Massachusetts General Hospital, 
      Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Smith 
      Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel 
      Deaconess Medical Center, Boston, Massachusetts.
FAU - Kirtane, Ajay
AU  - Kirtane A
AD  - Division of Cardiology, Department of Medicine, and Center for Interventional 
      Vascular Therapy, Columbia University, New York, New York.
FAU - Bangalore, Sripal
AU  - Bangalore S
AD  - Division of Cardiology, Department of Medicine, New York University School of 
      Medicine, New York, New York.
FAU - Jovin, Ion S
AU  - Jovin IS
AD  - Division of Cardiology, Department of Medicine, Virginia Commonwealth University, 
      Richmond, Virginia.
FAU - Shah, Rachit M
AU  - Shah RM
AD  - Division of Cardiology, Department of Medicine, Virginia Commonwealth University, 
      Richmond, Virginia.
FAU - Ferro, Enrico G
AU  - Ferro EG
AD  - Harvard Medical School, Boston, Massachusetts.
FAU - Wimmer, Neil J
AU  - Wimmer NJ
AD  - Division of Cardiology, Department of Medicine, Christiana Care Health System, 
      Newark, Delaware.
FAU - Roe, Matthew
AU  - Roe M
AD  - Duke Clinical Research Institute, Duke University, Durham, North Carolina.
FAU - Dai, Dadi
AU  - Dai D
AD  - Duke Clinical Research Institute, Duke University, Durham, North Carolina.
FAU - Mauri, Laura
AU  - Mauri L
AD  - Harvard Medical School, Boston, Massachusetts; Division of Cardiovascular 
      Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, 
      Massachusetts.
FAU - Yeh, Robert W
AU  - Yeh RW
AD  - Harvard Medical School, Boston, Massachusetts; Smith Center for Outcomes Research 
      in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, 
      Boston, Massachusetts. Electronic address: ryeh@bidmc.harvard.edu.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20161109
PL  - United States
TA  - JACC Cardiovasc Interv
JT  - JACC. Cardiovascular interventions
JID - 101467004
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
CIN - JACC Cardiovasc Interv. 2016 Dec 12;9(23):2387-2389. PMID: 27838264
MH  - Aged
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Antithrombins/adverse effects/*therapeutic use
MH  - Comparative Effectiveness Research
MH  - Coronary Thrombosis/etiology/prevention & control
MH  - Drug Utilization Review
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - Heparin/adverse effects/*therapeutic use
MH  - Hirudins/adverse effects
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Peptide Fragments/adverse effects/*therapeutic use
MH  - *Percutaneous Coronary Intervention/adverse effects/mortality
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Practice Patterns, Physicians'/*trends
MH  - Recombinant Proteins/adverse effects/therapeutic use
MH  - Registries
MH  - Risk Factors
MH  - ST Elevation Myocardial Infarction/diagnostic imaging/mortality/*therapy
MH  - Time Factors
MH  - Treatment Outcome
MH  - United States
OTO - NOTNLM
OT  - ST-segment elevation myocardial infarction
OT  - bivalirudin
OT  - bleeding
OT  - mortality
OT  - percutaneous coronary intervention
EDAT- 2016/11/14 06:00
MHDA- 2017/10/27 06:00
CRDT- 2016/11/14 06:00
PHST- 2016/08/23 00:00 [received]
PHST- 2016/09/08 00:00 [revised]
PHST- 2016/09/08 00:00 [accepted]
PHST- 2016/11/14 06:00 [pubmed]
PHST- 2017/10/27 06:00 [medline]
PHST- 2016/11/14 06:00 [entrez]
AID - S1936-8798(16)31546-1 [pii]
AID - 10.1016/j.jcin.2016.09.020 [doi]
PST - ppublish
SO  - JACC Cardiovasc Interv. 2016 Dec 12;9(23):2376-2386. doi: 
      10.1016/j.jcin.2016.09.020. Epub 2016 Nov 9.