Author + information
- Hitinder S. Gurm,
- Milan Seth,
- Mohamad Kenaan,
- Stanley Chetcuti,
- Simon Dixon,
- David Share,
- Paul Grossman and
- Mauro Moscucci
Bivalirudin compared with platelet glycoprotein IIbIIIa inhibitors (GPI) was associated with reduced bleeding, increased stent thrombosis and improved survival in patients undergoing primary PCI (PPCI) in the HORIZONS AMI trial. These findings have not been externally corroborated.
Our study cohort comprised of patients undergoing PPCI across 47 hospitals in Michigan between 2010 and 2012. Patients receiving Bivalirudin +/− GPI were compared to those receiving heparin + GPI. Propensity score matching (PSM) on a 1:1 basis without replacement was utilized to account for confounding.
Of 10,985 admissions for PPCI included in the analysis, Bivalirudin was used in 2,603 (24%) and GPI in 8,382 (76%). In-hospital mortality was similar, both overall (4.9% Bival vs. 5.0% GPI, p = 0.8) and after PSM (4.8% vs. 4.7%, p =0.9). GPI use was associated with increased post PCI bleeding events (overall: 4.1% vs. 7.4%, p < .001; PSM: 4.0% vs. 6.9%, p <.001), no difference in transfusion rates (overall 5.8% vs 6.9%, p = .052, PSM 5.7% vs 6.3%, p = 0.37) and a reduction in early stent thrombosis (overall: 0.56% versus 1.11%, p =0.004; PSM: 0.63% vs. 1.11%, P=0.09) Among 2,658 patients (median 1.2 years) for whom follow up data were available, no significant difference in mortality was observed (figure, p = .63).
Bivalirudin and GPI anticoagulation strategies appear to be associated with similar early and late mortality in this large unselected cohort of patients undergoing primary PCI.
Sunday, March 30, 2014, 9:45 a.m.-10:30 a.m.
Session Title: PCI Pharmacology
Abstract Category: 36. TCT@ACC-i2: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 2105-286
- 2014 American College of Cardiology Foundation