PMID- 28855222
OWN - NLM
STAT- MEDLINE
DCOM- 20180611
LR  - 20180611
IS  - 1941-7705 (Electronic)
IS  - 1941-7713 (Linking)
VI  - 10
IP  - 9
DP  - 2017 Sep
TI  - Practice Patterns and In-Hospital Outcomes Associated With Bivalirudin Use Among 
      Patients With Non-ST-Segment-Elevation Myocardial Infarction Undergoing 
      Percutaneous Coronary Intervention in the United States.
LID - e003741 [pii]
LID - 10.1161/CIRCOUTCOMES.117.003741 [doi]
AB  - BACKGROUND: Practice patterns in anticoagulant strategies used during 
      percutaneous coronary intervention (PCI) in the United States for patients with 
      non-ST-segment-elevation myocardial infarction and the comparative outcomes 
      between bivalirudin and unfractionated heparin (UFH) have not been well 
      described. METHODS AND RESULTS: Trends in anticoagulant use were examined among 
      553 562 PCIs performed by 9254 operators at 1538 hospitals for 
      non-ST-segment-elevation myocardial infarction from 2009 to 2014 within the 
      CathPCI Registry. To compare bivalirudin with UFH, propensity score matching and 
      instrumental variable (IV) methods with operator preference for bivalirudin as 
      the instrument were used. To determine whether differences in outcomes were 
      because of differences in glycoprotein IIb/IIIa inhibitor (GPI) use, a test of 
      mediation was performed using the IV. Outcomes were in-hospital bleeding and 
      mortality. Bivalirudin use increased from 2009 to 2013 but declined during 2014. 
      GPI use was 50.5% during UFH PCIs and 12.0% during bivalirudin PCIs. Before GPI 
      adjustment, bleeding reductions with bivalirudin ranged from 2.04% (IV: 95% 
      confidence interval [CI]: 1.81%, 2.27%) to 2.29% (propensity score: 95% CI: 
      2.14%, 2.44%) and mortality reductions ranged from 0.16% (IV: 95% CI: 0.03%, 
      0.28%) to 0.25% (propensity score: 95% CI: 0.17%, 0.33%). After GPI adjustment in 
      the IV, more than half the bleeding reduction with bivalirudin was because of the 
      lower use of GPIs (risk difference, -0.84%; 95% CI: -1.11%, -0.57%), and no 
      survival benefit was apparent (risk difference, -0.10%; 95% CI: -0.24%, 0.05%). 
      Bleeding reductions with bivalirudin were largest for transfemoral PCI 
      (GPI-adjusted risk difference, -1.11%; 95% CI: -1.43%, -0.80%) and negligible for 
      transradial PCI (GPI-adjusted risk difference, 0.09%; 95% CI: -0.32%, 0.50%). 
      CONCLUSIONS: In the largest comparative analysis of bivalirudin versus UFH for 
      non-ST-segment-elevation myocardial infarction to date, bivalirudin was 
      associated with lower in-hospital bleeding and mortality given current practices 
      with respect to GPI use and access site. Bleeding differences were, in part, 
      explained by the greater use of GPIs with UFH. Reductions in bleeding were 
      largest among those undergoing transfemoral PCI, whereas no bleeding benefit was 
      observed for those treated with transradial PCI.
CI  - (c) 2017 American Heart Association, Inc.
FAU - Secemsky, Eric A
AU  - Secemsky EA
AD  - From the Division of Cardiology, Department of Medicine, Massachusetts General 
      Hospital, Boston (E.A.S.); Harvard Medical School, Boston, MA (E.A.S., E.G.F., 
      L.M., R.W.Y.); Smith Center for Outcomes Research in Cardiology; Beth Israel 
      Deaconess Medical Center, Boston, MA (E.A.S., R.W.Y.); Division of Cardiology, 
      Department of Medicine, Center for Interventional Vascular Therapy, New York, NY 
      (A.K.); Columbia University, New York, NY (A.K.); Division of Cardiology, 
      Department of Medicine, New York University School of Medicine (S.B.); Division 
      of Cardiology, Department of Medicine, Virginia Commonwealth University, 
      Richmond, VA (I.S.J., D.P.); Division of Cardiology, Department of Medicine; 
      Christiana Care Health System, Newark, DE (N.J.W.); Duke Clinical Research 
      Institute, Duke University, Durham, NC (M.R., D.D.); and Division of 
      Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 
      Boston, MA (L.M.).
FAU - Kirtane, Ajay
AU  - Kirtane A
AD  - From the Division of Cardiology, Department of Medicine, Massachusetts General 
      Hospital, Boston (E.A.S.); Harvard Medical School, Boston, MA (E.A.S., E.G.F., 
      L.M., R.W.Y.); Smith Center for Outcomes Research in Cardiology; Beth Israel 
      Deaconess Medical Center, Boston, MA (E.A.S., R.W.Y.); Division of Cardiology, 
      Department of Medicine, Center for Interventional Vascular Therapy, New York, NY 
      (A.K.); Columbia University, New York, NY (A.K.); Division of Cardiology, 
      Department of Medicine, New York University School of Medicine (S.B.); Division 
      of Cardiology, Department of Medicine, Virginia Commonwealth University, 
      Richmond, VA (I.S.J., D.P.); Division of Cardiology, Department of Medicine; 
      Christiana Care Health System, Newark, DE (N.J.W.); Duke Clinical Research 
      Institute, Duke University, Durham, NC (M.R., D.D.); and Division of 
      Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 
      Boston, MA (L.M.).
FAU - Bangalore, Sripal
AU  - Bangalore S
AD  - From the Division of Cardiology, Department of Medicine, Massachusetts General 
      Hospital, Boston (E.A.S.); Harvard Medical School, Boston, MA (E.A.S., E.G.F., 
      L.M., R.W.Y.); Smith Center for Outcomes Research in Cardiology; Beth Israel 
      Deaconess Medical Center, Boston, MA (E.A.S., R.W.Y.); Division of Cardiology, 
      Department of Medicine, Center for Interventional Vascular Therapy, New York, NY 
      (A.K.); Columbia University, New York, NY (A.K.); Division of Cardiology, 
      Department of Medicine, New York University School of Medicine (S.B.); Division 
      of Cardiology, Department of Medicine, Virginia Commonwealth University, 
      Richmond, VA (I.S.J., D.P.); Division of Cardiology, Department of Medicine; 
      Christiana Care Health System, Newark, DE (N.J.W.); Duke Clinical Research 
      Institute, Duke University, Durham, NC (M.R., D.D.); and Division of 
      Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 
      Boston, MA (L.M.).
FAU - Jovin, Ion S
AU  - Jovin IS
AD  - From the Division of Cardiology, Department of Medicine, Massachusetts General 
      Hospital, Boston (E.A.S.); Harvard Medical School, Boston, MA (E.A.S., E.G.F., 
      L.M., R.W.Y.); Smith Center for Outcomes Research in Cardiology; Beth Israel 
      Deaconess Medical Center, Boston, MA (E.A.S., R.W.Y.); Division of Cardiology, 
      Department of Medicine, Center for Interventional Vascular Therapy, New York, NY 
      (A.K.); Columbia University, New York, NY (A.K.); Division of Cardiology, 
      Department of Medicine, New York University School of Medicine (S.B.); Division 
      of Cardiology, Department of Medicine, Virginia Commonwealth University, 
      Richmond, VA (I.S.J., D.P.); Division of Cardiology, Department of Medicine; 
      Christiana Care Health System, Newark, DE (N.J.W.); Duke Clinical Research 
      Institute, Duke University, Durham, NC (M.R., D.D.); and Division of 
      Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 
      Boston, MA (L.M.).
FAU - Patel, Dhavalkumar
AU  - Patel D
AD  - From the Division of Cardiology, Department of Medicine, Massachusetts General 
      Hospital, Boston (E.A.S.); Harvard Medical School, Boston, MA (E.A.S., E.G.F., 
      L.M., R.W.Y.); Smith Center for Outcomes Research in Cardiology; Beth Israel 
      Deaconess Medical Center, Boston, MA (E.A.S., R.W.Y.); Division of Cardiology, 
      Department of Medicine, Center for Interventional Vascular Therapy, New York, NY 
      (A.K.); Columbia University, New York, NY (A.K.); Division of Cardiology, 
      Department of Medicine, New York University School of Medicine (S.B.); Division 
      of Cardiology, Department of Medicine, Virginia Commonwealth University, 
      Richmond, VA (I.S.J., D.P.); Division of Cardiology, Department of Medicine; 
      Christiana Care Health System, Newark, DE (N.J.W.); Duke Clinical Research 
      Institute, Duke University, Durham, NC (M.R., D.D.); and Division of 
      Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 
      Boston, MA (L.M.).
FAU - Ferro, Enrico G
AU  - Ferro EG
AD  - From the Division of Cardiology, Department of Medicine, Massachusetts General 
      Hospital, Boston (E.A.S.); Harvard Medical School, Boston, MA (E.A.S., E.G.F., 
      L.M., R.W.Y.); Smith Center for Outcomes Research in Cardiology; Beth Israel 
      Deaconess Medical Center, Boston, MA (E.A.S., R.W.Y.); Division of Cardiology, 
      Department of Medicine, Center for Interventional Vascular Therapy, New York, NY 
      (A.K.); Columbia University, New York, NY (A.K.); Division of Cardiology, 
      Department of Medicine, New York University School of Medicine (S.B.); Division 
      of Cardiology, Department of Medicine, Virginia Commonwealth University, 
      Richmond, VA (I.S.J., D.P.); Division of Cardiology, Department of Medicine; 
      Christiana Care Health System, Newark, DE (N.J.W.); Duke Clinical Research 
      Institute, Duke University, Durham, NC (M.R., D.D.); and Division of 
      Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 
      Boston, MA (L.M.).
FAU - Wimmer, Neil J
AU  - Wimmer NJ
AD  - From the Division of Cardiology, Department of Medicine, Massachusetts General 
      Hospital, Boston (E.A.S.); Harvard Medical School, Boston, MA (E.A.S., E.G.F., 
      L.M., R.W.Y.); Smith Center for Outcomes Research in Cardiology; Beth Israel 
      Deaconess Medical Center, Boston, MA (E.A.S., R.W.Y.); Division of Cardiology, 
      Department of Medicine, Center for Interventional Vascular Therapy, New York, NY 
      (A.K.); Columbia University, New York, NY (A.K.); Division of Cardiology, 
      Department of Medicine, New York University School of Medicine (S.B.); Division 
      of Cardiology, Department of Medicine, Virginia Commonwealth University, 
      Richmond, VA (I.S.J., D.P.); Division of Cardiology, Department of Medicine; 
      Christiana Care Health System, Newark, DE (N.J.W.); Duke Clinical Research 
      Institute, Duke University, Durham, NC (M.R., D.D.); and Division of 
      Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 
      Boston, MA (L.M.).
FAU - Roe, Matthew
AU  - Roe M
AD  - From the Division of Cardiology, Department of Medicine, Massachusetts General 
      Hospital, Boston (E.A.S.); Harvard Medical School, Boston, MA (E.A.S., E.G.F., 
      L.M., R.W.Y.); Smith Center for Outcomes Research in Cardiology; Beth Israel 
      Deaconess Medical Center, Boston, MA (E.A.S., R.W.Y.); Division of Cardiology, 
      Department of Medicine, Center for Interventional Vascular Therapy, New York, NY 
      (A.K.); Columbia University, New York, NY (A.K.); Division of Cardiology, 
      Department of Medicine, New York University School of Medicine (S.B.); Division 
      of Cardiology, Department of Medicine, Virginia Commonwealth University, 
      Richmond, VA (I.S.J., D.P.); Division of Cardiology, Department of Medicine; 
      Christiana Care Health System, Newark, DE (N.J.W.); Duke Clinical Research 
      Institute, Duke University, Durham, NC (M.R., D.D.); and Division of 
      Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 
      Boston, MA (L.M.).
FAU - Dai, David
AU  - Dai D
AD  - From the Division of Cardiology, Department of Medicine, Massachusetts General 
      Hospital, Boston (E.A.S.); Harvard Medical School, Boston, MA (E.A.S., E.G.F., 
      L.M., R.W.Y.); Smith Center for Outcomes Research in Cardiology; Beth Israel 
      Deaconess Medical Center, Boston, MA (E.A.S., R.W.Y.); Division of Cardiology, 
      Department of Medicine, Center for Interventional Vascular Therapy, New York, NY 
      (A.K.); Columbia University, New York, NY (A.K.); Division of Cardiology, 
      Department of Medicine, New York University School of Medicine (S.B.); Division 
      of Cardiology, Department of Medicine, Virginia Commonwealth University, 
      Richmond, VA (I.S.J., D.P.); Division of Cardiology, Department of Medicine; 
      Christiana Care Health System, Newark, DE (N.J.W.); Duke Clinical Research 
      Institute, Duke University, Durham, NC (M.R., D.D.); and Division of 
      Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 
      Boston, MA (L.M.).
FAU - Mauri, Laura
AU  - Mauri L
AD  - From the Division of Cardiology, Department of Medicine, Massachusetts General 
      Hospital, Boston (E.A.S.); Harvard Medical School, Boston, MA (E.A.S., E.G.F., 
      L.M., R.W.Y.); Smith Center for Outcomes Research in Cardiology; Beth Israel 
      Deaconess Medical Center, Boston, MA (E.A.S., R.W.Y.); Division of Cardiology, 
      Department of Medicine, Center for Interventional Vascular Therapy, New York, NY 
      (A.K.); Columbia University, New York, NY (A.K.); Division of Cardiology, 
      Department of Medicine, New York University School of Medicine (S.B.); Division 
      of Cardiology, Department of Medicine, Virginia Commonwealth University, 
      Richmond, VA (I.S.J., D.P.); Division of Cardiology, Department of Medicine; 
      Christiana Care Health System, Newark, DE (N.J.W.); Duke Clinical Research 
      Institute, Duke University, Durham, NC (M.R., D.D.); and Division of 
      Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 
      Boston, MA (L.M.).
FAU - Yeh, Robert W
AU  - Yeh RW
AD  - From the Division of Cardiology, Department of Medicine, Massachusetts General 
      Hospital, Boston (E.A.S.); Harvard Medical School, Boston, MA (E.A.S., E.G.F., 
      L.M., R.W.Y.); Smith Center for Outcomes Research in Cardiology; Beth Israel 
      Deaconess Medical Center, Boston, MA (E.A.S., R.W.Y.); Division of Cardiology, 
      Department of Medicine, Center for Interventional Vascular Therapy, New York, NY 
      (A.K.); Columbia University, New York, NY (A.K.); Division of Cardiology, 
      Department of Medicine, New York University School of Medicine (S.B.); Division 
      of Cardiology, Department of Medicine, Virginia Commonwealth University, 
      Richmond, VA (I.S.J., D.P.); Division of Cardiology, Department of Medicine; 
      Christiana Care Health System, Newark, DE (N.J.W.); Duke Clinical Research 
      Institute, Duke University, Durham, NC (M.R., D.D.); and Division of 
      Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 
      Boston, MA (L.M.). ryeh@bidmc.harvard.edu.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Circ Cardiovasc Qual Outcomes
JT  - Circulation. Cardiovascular quality and outcomes
JID - 101489148
RN  - 0 (Antithrombins)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Aged
MH  - Antithrombins/administration & dosage
MH  - Blood Loss, Surgical/*mortality
MH  - Female
MH  - Hirudins/*administration & dosage
MH  - Hospital Mortality/trends
MH  - Humans
MH  - Incidence
MH  - *Inpatients
MH  - Male
MH  - Middle Aged
MH  - Non-ST Elevated Myocardial Infarction/mortality/*therapy
MH  - Peptide Fragments/*administration & dosage
MH  - *Percutaneous Coronary Intervention
MH  - Postoperative Hemorrhage/*epidemiology
MH  - *Practice Patterns, Physicians'
MH  - Recombinant Proteins/administration & dosage
MH  - Registries
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Treatment Outcome
MH  - United States/epidemiology
OTO - NOTNLM
OT  - anticoagulants
OT  - bivalirudin
OT  - comparative effectiveness research
OT  - hemorrhage
OT  - hospital mortality
OT  - non-ST elevated myocardial infarction
OT  - percutaneous coronary intervention
EDAT- 2017/09/01 06:00
MHDA- 2018/06/12 06:00
CRDT- 2017/09/01 06:00
PHST- 2017/03/09 00:00 [received]
PHST- 2017/07/28 00:00 [accepted]
PHST- 2017/09/01 06:00 [entrez]
PHST- 2017/09/01 06:00 [pubmed]
PHST- 2018/06/12 06:00 [medline]
AID - CIRCOUTCOMES.117.003741 [pii]
AID - 10.1161/CIRCOUTCOMES.117.003741 [doi]
PST - ppublish
SO  - Circ Cardiovasc Qual Outcomes. 2017 Sep;10(9):e003741. doi: 
      10.1161/CIRCOUTCOMES.117.003741.