PMID- 31786531
OWN - NLM
STAT- MEDLINE
DCOM- 20200604
LR  - 20200604
IS  - 1557-2501 (Electronic)
IS  - 1042-3931 (Linking)
VI  - 31
IP  - 12
DP  - 2019 Dec
TI  - Periprocedural Bivalirudin Versus Unfractionated Heparin During Percutaneous 
      Coronary Intervention Following Fibrinolysis for ST-Segment Elevation Myocardial 
      Infarction.
PG  - E387-E391
AB  - BACKGROUND: A pharmacoinvasive strategy for ST-segment elevation myocardial 
      infarction (STEMI) management combines the use of fibrinolysis with the routine 
      transfer to coronary angiography, with percutaneous coronary intervention (PCI) 
      if needed. This method reduces the risk of major adverse cardiovascular event 
      (MACE) compared with fibrinolysis alone; however, it is associated with higher 
      bleeding risk. We sought to assess the bivalirudin compared with unfractionated 
      heparin (UFH) used during PCI as part of a pharmacoinvasive strategy. METHODS: We 
      identified consecutive patients referred to the University of Ottawa Heart 
      Institute between April 2009 and May 2011 as part of a pharmacoinvasive strategy 
      for STEMI. The primary efficacy outcome was MACE, defined as a composite of 
      death, reinfarction, or stroke during index hospitalization. The primary safety 
      outcome was TIMI bleeding. RESULTS: We identified 200 patients meeting inclusion 
      criteria: 123 patients (61.5%) in the bivalirudin group and 77 patients (37.5%) 
      in the UFH group. Median fibrinolysis to balloon time was 324 minutes in the 
      bivalirudin group and 226 minutes in the UFH group (P<.001). Initial TIMI grade 3 
      flow was higher in the bivalirudin group vs the UFH group, but there was no 
      difference in the rates post PCI. MACE rates were 4.9% vs 7.8% (P=.40) and TIMI 
      bleeding rates were 7.3% vs 11.7% (P=.29) in patients treated with bivalirudin vs 
      UFH, respectively. CONCLUSION: The periprocedural use of bivalirudin vs UFH was 
      associated with similar rates of MACE and bleeding. Given the expense of 
      bivalirudin and lack of demonstrable clinical superiority, UFH remains the 
      first-line periprocedural anticoagulant in a pharmacoinvasive strategy.
FAU - Rashid, Mohammed K
AU  - Rashid MK
FAU - Singh, Kuljit
AU  - Singh K
FAU - Bernick, Jordan
AU  - Bernick J
FAU - Wells, George A
AU  - Wells GA
FAU - Hibbert, Benjamin
AU  - Hibbert B
FAU - Russo, Juan
AU  - Russo J
FAU - So, Derek Y
AU  - So DY
FAU - Le May, Michel R
AU  - Le May MR
AD  - University of Ottawa Heart Institute, 40 Ruskin street, Ottawa, Ontario K1Y 4W7, 
      Canada. mlemay@ottawaheart.ca.
CN  - CAPITAL PCI Group
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Invasive Cardiol
JT  - The Journal of invasive cardiology
JID - 8917477
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  - Coronary Angiography/methods
MH  - Female
MH  - Fibrinolytic Agents/administration & dosage/adverse effects
MH  - *Hemorrhage/chemically induced/prevention & control
MH  - *Heparin/administration & dosage/adverse effects
MH  - *Hirudins/administration & dosage/adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Outcome and Process Assessment, Health Care
MH  - *Peptide Fragments/administration & dosage/adverse effects
MH  - *Percutaneous Coronary Intervention/adverse effects/methods
MH  - Perioperative Care/methods
MH  - Postoperative Complications/*prevention & control
MH  - Recombinant Proteins/administration & dosage/adverse effects
MH  - Risk Adjustment/methods
MH  - *ST Elevation Myocardial Infarction/mortality/therapy
OTO - NOTNLM
OT  - PCI post fibrinolysis
OT  - acute myocardial infarction
OT  - periprocedural anticoagulation
EDAT- 2019/12/02 06:00
MHDA- 2020/06/05 06:00
CRDT- 2019/12/02 06:00
PHST- 2019/12/02 06:00 [entrez]
PHST- 2019/12/02 06:00 [pubmed]
PHST- 2020/06/05 06:00 [medline]
PST - ppublish
SO  - J Invasive Cardiol. 2019 Dec;31(12):E387-E391.