Author + information
- Pierre Deharo,
- Raveen Kandan,
- Hazim Rahbi,
- Abdul Mozid,
- Stephen Dorman,
- Tom Johnson,
- Julian Strange and
- Andreas Baumbach
Background: Despite initial promising results, HEAT PPCI trial showed no benefit and even harm associated with the use of bivalirudin vs. heparin in primary PCI (pPCI). Before HEAT PCI results, the standard of care in our center was bivalirudin, unless contraindication, associated with a new P2Y12 blocker (i.e. ticagrelor or prasugrel) for pPCI. From May 2015, we moved to systematic heparin use.
Methods: We aimed to analyze the differences in clinical outcomes and financial costs following the reintroduction of heparin as the standard anticoagulation in patients treated for pPCI in our center. A before-after study has been performed on two different periods corresponding to two different protocols of anticoagulation for pPCI.
Results: Between May 2014 to May 2016, 1291 patients underwent a pPCI, corresponding to 662 in the before and 629 in the after cohort. In the before cohort 75% of the patients were treated with bivalirudin while 25% have had heparin. In the after cohort 99% of patients had heparin and 1% of bivalirudin. Baseline and procedural characteristics were not significantly different, except a higher use of thromboaspiration (45% vs. 12%) and femoral access (20% vs. 13%) in the before cohort. Gp2b3a antagonists were used in 24% of the patients in the before arm vs. 28% in the after (p<0.01). At 30 days, we observed 62 (9.4%) death in the before cohort vs. 56 in the after (8.9%) (p= 0.84); 5 (0.8%) vs.3 (0.5%) cerebrovascular events (p= 0.73); 4 (0.6%) vs. 7 (1.1%) unplanned target lesion revascularization (p=0.38) and 3 (0.5%) vs. 2 (0.3%) definite stent thrombosis (p=1.00), respectively. We observed 73 (11.0%) vs. 71 (11.3%) deaths at 180 days (p= 0.93). We reported 145 (21.9%) of all BARC bleeding events in the before arm vs. 138 (21.9%) in the after arm (p=1.00). BARC≥2 bleedings were reported in 102 (15.4%) vs.115 (18.3%) (p=0.18), respectively. The estimated cost of anticoagulation was drastically different between the before and after periods (£246236 vs. £4483 respectively; p<0.01)
Conclusions: The reintroduction of heparin in pPCI pathway has not led to significant differences in bleeding or ischemic outcomes. However, it has translated in an economic benefit with significant cost saving.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Considerations in Antiplatelet Therapy and in ACS
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1113-147
- 2017 American College of Cardiology Foundation