PMID- 29910059
OWN - NLM
STAT- MEDLINE
DCOM- 20190418
LR  - 20190418
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 201
DP  - 2018 Jul
TI  - Bivalirudin versus heparin with primary percutaneous coronary intervention.
PG  - 9-16
LID - S0002-8703(18)30089-9 [pii]
LID - 10.1016/j.ahj.2018.03.014 [doi]
AB  - BACKGROUND: Optimal adjunctive therapy in ST-segment elevation myocardial 
      infarction (STEMI) patients treated with primary PCI (PPCI) remains a matter of 
      debate. Our aim was to compare the efficacy and safety of bivalirudin to 
      unfractionated heparin (UFH), with or without glycoprotein IIb/IIIa inhibitors 
      (GPI) in a large real-world population, using data from the Swedish national 
      registry, SWEDEHEART. METHOD: From 2008 to 2014 we identified 23,800 STEMI 
      patients presenting within 12 hours from symptom onset treated with PPCI and 
      UFH +/- GPI or bivalirudin+/-GPI. Primary outcomes included 30-day all-cause 
      mortality and major in-hospital bleeding. Multivariable regression models and 
      propensity score modelling were utilized to study adjusted association between 
      treatment and outcome. RESULTS: Treatment with UFH +/- GPI was associated with 
      similar risk of 30-day mortality compared to bivalirudin+/-GPI (5.3% vs 5.5%, 
      adjusted HR 0.94; 95% CI 0.82-1.07). The adjusted risk for 1-year mortality, 
      30-day and 1-year stent thrombosis and re-infarction did not differ significantly 
      between UFH +/- GPI and bivalirudin+/-GPI. In contrast, treatment with UFH +/- GPI was 
      associated with a significant higher risk of major in-hospital bleeding (adjusted 
      OR 1.62; 95% CI 1.30-2.03). When including GPI use in the multivariable analysis, 
      the difference was attenuated and no longer significant (adjusted OR 1.25; 95% CI 
      0.92-1.70). CONCLUSION: Bivalirudin+/-GPI was associated with significantly lower 
      risk for major inhospital bleeding but no significant difference in 30-day or one 
      year mortality, stent thrombosis or re-infarction compared with UFH +/- GPI. The 
      bleeding reduction associated with bivalirudin could be explained by the greater 
      GPI use with UFH.
CI  - Copyright (c) 2018 Elsevier Inc. All rights reserved.
FAU - Venetsanos, Dimitrios
AU  - Venetsanos D
AD  - Department of Cardiology and Department of Medical and Health Sciences, Linkoping 
      University, Linkoping, Sweden. Electronic address: dimitrios.venetsanos@liu.se.
FAU - Lawesson, Sofia Sederholm
AU  - Lawesson SS
AD  - Department of Cardiology and Department of Medical and Health Sciences, Linkoping 
      University, Linkoping, Sweden.
FAU - James, Stefan
AU  - James S
AD  - Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
FAU - Koul, Sasha
AU  - Koul S
AD  - Department of Cardiology, Clinical Sciences, Lund University, Skane University 
      Hospital, Lund, Sweden.
FAU - Erlinge, David
AU  - Erlinge D
AD  - Department of Cardiology, Clinical Sciences, Lund University, Skane University 
      Hospital, Lund, Sweden.
FAU - Swahn, Eva
AU  - Swahn E
AD  - Department of Cardiology and Department of Medical and Health Sciences, Linkoping 
      University, Linkoping, Sweden.
FAU - Alfredsson, Joakim
AU  - Alfredsson J
AD  - Department of Cardiology and Department of Medical and Health Sciences, Linkoping 
      University, Linkoping, Sweden.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20180328
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Antithrombins)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Aged
MH  - Antithrombins/therapeutic use
MH  - Cause of Death/trends
MH  - Coronary Angiography
MH  - Coronary Restenosis/epidemiology/*prevention & control
MH  - Female
MH  - Fibrinolytic Agents/therapeutic use
MH  - Follow-Up Studies
MH  - Heparin/*therapeutic use
MH  - Hirudins
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Peptide Fragments/*therapeutic use
MH  - Percutaneous Coronary Intervention/*methods
MH  - Recombinant Proteins/therapeutic use
MH  - *Registries
MH  - Retrospective Studies
MH  - ST Elevation Myocardial Infarction/diagnosis/*surgery
MH  - *Stents
MH  - Sweden/epidemiology
MH  - Treatment Outcome
EDAT- 2018/06/19 06:00
MHDA- 2019/04/19 06:00
CRDT- 2018/06/19 06:00
PHST- 2017/10/31 00:00 [received]
PHST- 2018/03/21 00:00 [accepted]
PHST- 2018/06/19 06:00 [entrez]
PHST- 2018/06/19 06:00 [pubmed]
PHST- 2019/04/19 06:00 [medline]
AID - S0002-8703(18)30089-9 [pii]
AID - 10.1016/j.ahj.2018.03.014 [doi]
PST - ppublish
SO  - Am Heart J. 2018 Jul;201:9-16. doi: 10.1016/j.ahj.2018.03.014. Epub 2018 Mar 28.