Article Text

PDF

29 Bivalirudin in patients undergoing primary percutaneous coronary intervention for acute ST-elevation myocardial infarction: outcomes in a large real-world UK population
  1. C Eftychiou1,
  2. R J Shelton1,
  3. A Liu1,
  4. K Somers1,
  5. P Tooze1,
  6. L Makri2,
  7. D Barmby1,
  8. J M McLenachan1,
  9. J M Blaxill1,
  10. S B Wheatcroft1,
  11. J P Greenwood1,
  12. D J Blackman1
  1. 1Leeds General Infirmary, Leeds, UK
  2. 2Statistical service of Cyprus, Nicosia, Cyprus

Abstract

Background The HORIZONS-AMI trial demonstrated a significantly lower early and late mortality in patients undergoing primary PCI (PPCI) treated with bivalirudin compared to a Glycoprotein IIb/IIIa inhibitor (GPI) + heparin. However, concerns remain regarding the increased incidence of acute stent thrombosis (ST) with bivalirudin, the apparently worse outcomes in the absence of additional pre-procedural heparin, and the translation of trial results into a real-world population. We evaluated the outcomes of patients undergoing PPCI with bivalirudin in a large all-comers UK setting.

Methods All patients who underwent PPCI in Leeds General Infirmary from 1 January 2009 to 31 December 2009 were prospectively entered into a dedicated registry. Demographic, procedural, and 30-day outcome data were obtained by abstraction from the ONS mortality database and BCIS PCI database, review of hospital notes, and telephone follow-up. Bivalirudin was administered as a bolus, high-dose intra-procedural infusion, and low-dose infusion for 4 h post-PCI. Additional heparin was not routinely given, but was favoured by some operators. Bail-out GPI was administered according to physician judgement. Primary endpoints were death, MACE (death, re-infarction, stroke, unplanned target vessel revascularisation (TVR)), and stent thrombosis (ST) (ARC definition definite/probable) at 30-days follow-up.

Results 968 patients (age 63.5±13 years, 71.9% male, 13.2% diabetics) underwent PPCI. Bivalirudin was given in 882 patients (91.1%), and GPI + heparin in 85 (8.8%). Of bivalirudin-treated patients 100 (11.3%) also received heparin (29 pre-PCI and 80 during) while bail-out GPI was used in 91 (10.3%). Thirty-day outcomes are shown in Abstract 29 table 1. All-cause mortality was 5.2% in the bivalirudin treated patients. Acute ST occurred in 1.0%, a median of 2 h post-PCI, and within 6 h in 90%. Mortality in patients who suffered acute ST was 20%, compared to 80% following subacute ST. There was no difference in outcomes between bivalirudin treated patients who also received heparin compared to those who didn′t (death 7.0% vs 5.0%, p value: 0.80; MACE 14.0% vs 10.8%, p value: 0.32; acute ST 0% vs 1.2%, p: 0.61).

Abstract 29 Table 1

Outcomes at 30 days

Conclusion Routine use of bivalirudin in a large UK all-comers primary PCI population was associated with excellent 30-day outcomes, including all-cause and cardiac mortality. Acute stent thrombosis was infrequent, despite the absence of routine additional heparin.

  • Primary PCI
  • bivalirudin
  • acute coronary syndrome

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.