Author + information
- Morgan Kellogg,
- Yi-Ling Huang,
- Todd A. MacKenzie,
- Bina Ahmed,
- Matthew Watkins,
- Patrick Magnus,
- Jim Flynn,
- Peter N. Ver Lee,
- David Malenka,
- Samip C. Vasaiwala,
- The Northern New England Cardiovascular Disease Study Group
Bivalirudin has previously been shown to be associated with a reduction in the risk of bleeding associated with percutaneous coronary intervention (PCI) in the setting of acute coronary syndrome when compared with unfractionated heparin (UFH). More recent work has suggested this benefit to be largely secondary to asymmetry in IIb/IIIa inhibititor use. Whether this benefit persists in the setting of PCI for stable ischemic heart disease (SIHD) after adjusting for access site and IIb/IIIa inhibitor use remains unclear.
All patients undergoing PCI at a clinical site of The Northern New England Cardiovascular Disease Study Group from 2006-2016 for SIHD were evaluated. We excluded cases for which bivalirudin or UFH was not used, STEMI, documented shock and PCI for chronic total occlusion of a vessel. 8,588 patients treated with bivalirudin were compared with 3,941 treated with UFH using instrumental variable (IV) analysis which has been used in previous studies to adjust for unmeasured confounders. The rate of bivalirudin use per operator over the previous 6 months was used as an instrument to predict anticoagulant choice for the subsequent PCI. The IV analysis model was adjusted for pertinent clinical and demographic parameters along with access site and IIb/IIIa inhibitor use. Primary outcome of the study was bleeding events requiring transfusion.
Bivalirudin use increased from 2006 to 2010 from 88.7% to 90.3% of PCIs and declined by 2016 to 13.7%. IIb/IIIa inhibitor use tended lower throughout the study period and radial access increased. Bivalirudin use did not demonstrate a significant reduction in bleeding compared to unfractionated heparin (P = 0.92, Unadjusted bleeding rates: UFH=0.30%, Bivalirudin=0.44%).
IV analysis is a novel method which allows for adjustment of unmeasured confounders in comparative effectiveness analysis. With this method, bivalirudin use in PCI for SIHD was not associated with a reduction in the risk of bleeding after adjusting for access site and IIb/IIIa inhibitor use.
Poster Hall, Hall A/B
Sunday, March 11, 2018, 3:45 p.m.-4:30 p.m.
Session Title: Procedural Outcomes in Specific Patient Subsets
Abstract Category: 03. Acute and Stable Ischemic Heart Disease: Therapy
Presentation Number: 1263-475
- 2018 American College of Cardiology Foundation