PMID- 31883294
OWN - NLM
STAT- MEDLINE
DCOM- 20210809
LR  - 20210809
IS  - 1522-726X (Electronic)
IS  - 1522-1946 (Linking)
VI  - 96
IP  - 6
DP  - 2020 Nov
TI  - Assessment of residual thrombus burden in patients with ST-segment elevation 
      myocardial infarction undergoing bivalirudin versus unfractionated heparin 
      infusion: The MATRIX (minimizing adverse hemorrhagic events by transradial access 
      site and angioX) OCT study.
PG  - 1156-1171
LID - 10.1002/ccd.28661 [doi]
AB  - BACKGROUND: Residual stent strut thrombosis after primary percutaneous coronary 
      intervention (PCI), negatively affects myocardial perfusion, may increase stent 
      thrombosis risk, and it is associated with neointima hyperplasia at follow-up. 
      OBJECTIVES: To study the effectiveness of any bivalirudin infusion versus 
      unfractionated heparin (UFH) infusion in reducing residual stent strut thrombosis 
      in patients with ST-elevation myocardial infarction (STEMI). METHODS: 
      Multi-vessel STEMI patients undergoing primary PCI and requiring staged 
      intervention were selected among those randomly allocated to two different 
      bivalirudin infusion regimens in the MATRIX (Minimizing Adverse Haemorrhagic 
      Events by TRansradial Access Site and angioX) Treatment-Duration study. Those 
      receiving heparin only were enrolled into a registry arm. Optical coherence 
      tomography (OCT) of the infarct-related artery was performed at the end of 
      primary PCI and 3-5 days thereafter during a staged intervention. The primary 
      endpoint was the change in minimum flow area (DeltaMinFA) defined as (stent 
      area + incomplete stent apposition [ISA] area) - (intraluminal defect + tissue 
      prolapsed area) between the index and staged PCI. RESULTS: 123 patients in 
      bivalirudin arm and 28 patients in the UFH arm were included. Mean stent area, 
      percentage of malapposed struts, and mean percent thrombotic area were comparable 
      after index or staged PCI. The DeltaMinFA in the bivalirudin group was 0.25 versus 
      0.05 mm(2) in the UFH group, which resulted in a between-group significant 
      difference of 0.36 [95% CI: (0.05, 0.71); p = .02]. This was mostly related to a 
      decrease in tissue protrusion in the bivalirudin group (p = .03). There was a 
      trend towards more patients in the bivalirudin group who achieved a 5% difference 
      in the percentage of OCT frames with the area >5% (p = .057). CONCLUSIONS: The 
      administration of bivalirudin after primary PCI significantly reduces residual 
      stent strut thrombosis when compared to UFH. This observation should be 
      considered hypothesis-generating since the heparin-treated patients were not 
      randomly allocated.
CI  - (c) 2019 Wiley Periodicals, Inc.
FAU - Garcia-Garcia, Hector M
AU  - Garcia-Garcia HM
AUID- ORCID: 0000-0001-5100-0471
AD  - MedStar Washington Hospital Center, Washington, District of Columbia.
FAU - Adamo, Marianna
AU  - Adamo M
AD  - Department of Medical and Surgical Specialties, Radiological Sciences, and Public 
      Health, University of Brescia, Cardio-Thoracic Department, Civil Hospitals, 
      Brescia, Italy.
FAU - Soud, Mohamad
AU  - Soud M
AUID- ORCID: 0000-0003-2265-0875
AD  - Rutgers New Jersey Medical School, Newark, New Jersey.
FAU - Yacob, Omar
AU  - Yacob O
AD  - MedStar Washington Hospital Center, Washington, District of Columbia.
FAU - Picchi, Andrea
AU  - Picchi A
AD  - Cardiovascular and Neurologic Department, Misericordia Hospital, Grosseto, Italy.
FAU - Sardella, Gennaro
AU  - Sardella G
AD  - Department of Cardiology, Policlinico Umberto I, Sapienza University of Rome, 
      Rome, Italy.
FAU - Frigoli, Enrico
AU  - Frigoli E
AD  - Clinical Trials Unit, University of Bern, Bern, Switzerland.
FAU - Limbruno, Ugo
AU  - Limbruno U
AD  - Cardiovascular and Neurologic Department, Misericordia Hospital, Grosseto, Italy.
FAU - Rigattieri, Stefano
AU  - Rigattieri S
AUID- ORCID: 0000-0001-5116-2737
AD  - Division of Cardiology, Sant'Andrea Hospital, Rome, Italy.
FAU - Diletti, Roberto
AU  - Diletti R
AUID- ORCID: 0000-0002-2344-6705
AD  - Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
FAU - Boccuzzi, Giacomo
AU  - Boccuzzi G
AUID- ORCID: 0000-0003-4220-758X
AD  - Department of Cardiology, San Giovanni Bosco Hospital, Turin, Italy.
FAU - Zimarino, Marco
AU  - Zimarino M
AUID- ORCID: 0000-0001-5455-6010
AD  - Institute of Cardiology "G. d'Annunzio" University, Chieti, Italy.
FAU - Contarini, Marco
AU  - Contarini M
AD  - Interventional Cardiology Unit Umberto I Hospital, Syracuse, Italy.
FAU - Russo, Filippo
AU  - Russo F
AD  - Interventional Cardiology Unit, Cardio-thoracic-Vascular Department, San Raffaele 
      Scientific Institute, Milan, Italy.
FAU - Calabro, Paolo
AU  - Calabro P
AD  - Division of Cardiology, Department of Cardiothoracic and Respiratory Sciences, 
      University of Campania "Luigi Vanvitelli", Naples, Italy.
FAU - Ando, Giuseppe
AU  - Ando G
AUID- ORCID: 0000-0001-5552-6382
AD  - Department of Clinical and Experimental Medicine, University of Messina, Messina, 
      Italy.
FAU - Varbella, Ferdinando
AU  - Varbella F
AD  - Cardiology Unit, Ospedali Riuniti di Rivoli, Turin, Italy.
FAU - Garducci, Stefano
AU  - Garducci S
AD  - Unita' Operativa Complessa di Cardiologia ASST di Vimercate (MB), Vimercate, 
      Italy.
FAU - Palmieri, Cataldo
AU  - Palmieri C
AD  - Fondazione Toscana G. Monasterio - Ospedale del Cuore G. Pasquinucci, Pisa/Massa, 
      Massa, Italy.
FAU - Briguori, Carlo
AU  - Briguori C
AUID- ORCID: 0000-0002-2105-8186
AD  - Department of Cardiology, Interventional Cardiology, Mediterranea Cardiocentro, 
      Naples, Italy.
FAU - Karagiannis, Alexios
AU  - Karagiannis A
AD  - Clinical Trials Unit, University of Bern, Bern, Switzerland.
FAU - Valgimigli, Marco
AU  - Valgimigli M
AUID- ORCID: 0000-0002-4353-7110
AD  - Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
DEP - 20191228
PL  - United States
TA  - Catheter Cardiovasc Interv
JT  - Catheterization and cardiovascular interventions : official journal of the 
      Society for Cardiac Angiography & Interventions
JID - 100884139
RN  - 0 (Anticoagulants)
RN  - 0 (Antithrombins)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
CIN - Catheter Cardiovasc Interv. 2020 Nov;96(6):1172-1173. PMID: 33217184
MH  - Aged
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Antithrombins/*administration & dosage/adverse effects
MH  - Coronary Thrombosis/diagnostic imaging/*therapy
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - Heparin/*administration & dosage/adverse effects
MH  - Hirudins/*administration & dosage/adverse effects
MH  - Humans
MH  - Infusions, Parenteral
MH  - Italy
MH  - Male
MH  - Middle Aged
MH  - Neointima
MH  - Peptide Fragments/*administration & dosage/adverse effects
MH  - *Percutaneous Coronary Intervention/adverse effects/instrumentation
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Recombinant Proteins/administration & dosage/adverse effects
MH  - ST Elevation Myocardial Infarction/diagnostic imaging/*therapy
MH  - Stents
MH  - Time Factors
MH  - *Tomography, Optical Coherence
MH  - Treatment Outcome
OTO - NOTNLM
OT  - ST-segment elevation myocardial infarction
OT  - bivalirudin
OT  - heparin
OT  - optical coherence tomography
EDAT- 2019/12/29 06:00
MHDA- 2021/08/10 06:00
CRDT- 2019/12/29 06:00
PHST- 2019/07/10 00:00 [received]
PHST- 2019/12/08 00:00 [accepted]
PHST- 2019/12/29 06:00 [pubmed]
PHST- 2021/08/10 06:00 [medline]
PHST- 2019/12/29 06:00 [entrez]
AID - 10.1002/ccd.28661 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2020 Nov;96(6):1156-1171. doi: 10.1002/ccd.28661. 
      Epub 2019 Dec 28.