Author + information
- Jaya Reddy Mallidia,b,
- Muhammad Shakoora,b,
- Jane Garba,b,
- Daniel Fishera,b,
- Kurt Barringhausa,b and
- Amir Lotfia,b
Background: The interaction between access site and anticoagulant used during primary percutaneous coronary intervention (PCI) in patients presenting with ST segment elevation myocardial infarction (STEMI) is not well studied.
Aim/Hypothesis: Our aim was to compare clinical outcomes among STEMI patients undergoing primary PCI using bivalirudin via femoral route (bival/fem) with heparin via radial route (hep/rad). We hypothesized that there is no difference in clinical outcomes between the two groups.
Methods: We conducted a retrospective cohort study of all patients >18 years of age who presented with STEMI and underwent primary PCI in two large regional STEMI centers in Massachusetts between October 1, 2012 to December 31, 2014. Data was obtained using the electronic system that is routinely used to collect data on all STEMI patients. The cohort was divided into three groups – bival /fem, hep/rad and off-protocol based on the access site and anticoagulation used. We used multiple logistic regression model to compare major cardiovascular events – MACE (composite of death, myocardial infarction, stroke, stent thrombosis) and bleeding complications between the two on protocol groups (bival/fem and hep/ rad).
Results: A total of 1074 patients were included in this study. Of these, there are 443 (41%), 501 (47%) and 130 (12%) patients in bival/fem, hep/ rad and off -protocol groups respectively. The number of patients presenting with cardiogenic shock was significantly higher in the bival/fem group (6.5% vs. 3.0%, p <0.001). In a multivariable analysis, MACE was significantly lower in the hep/rad group compared to bival/fem (3.0 % vs. 5.6%, p=0.045). The rate of mortality was significantly lower in the hep/rad group compared to bival/fem group (1.4% vs. 5.0%, p=0.019) without any significant difference in rates of major bleeding (hep/rad: 5.0% vs. bival/fem: 8.1%, p=0.81).
Conclusions: This study shows that among patients presenting with STEMI, primary PCI done via radial route using heparin may be associated with better clinical outcomes compared to femoral route using bivalirudin.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Novel Developments in Acute Coronary Syndromes
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1194-151
- 2017 American College of Cardiology Foundation