Bivalirudin versus heparin with primary percutaneous coronary intervention
Venetsanos, Dimitrios ; Lawesson, Sofia Sederholm ; James, Stefan ; Koul, Sasha LU ; Erlinge, David LU
; Swahn, Eva
and Alfredsson, Joakim
(2018)
In American Heart Journal
201.
p.9-16
- Abstract
Background: Optimal adjunctive therapy in ST-segment elevation myocardial infarction (STEMI) patients treated with primary PCI (PPCI) remains a matter of debate. Our aim was to compare the efficacy and safety of bivalirudin to unfractionated heparin (UFH), with or without glycoprotein IIb/IIIa inhibitors (GPI) in a large real-world population, using data from the Swedish national registry, SWEDEHEART. Method: From 2008 to 2014 we identified 23,800 STEMI patients presenting within 12 hours from symptom onset treated with PPCI and UFH ± GPI or bivalirudin±GPI. Primary outcomes included 30-day all-cause mortality and major in-hospital bleeding. Multivariable regression models and propensity score modelling were utilized to study adjusted... (More)
Background: Optimal adjunctive therapy in ST-segment elevation myocardial infarction (STEMI) patients treated with primary PCI (PPCI) remains a matter of debate. Our aim was to compare the efficacy and safety of bivalirudin to unfractionated heparin (UFH), with or without glycoprotein IIb/IIIa inhibitors (GPI) in a large real-world population, using data from the Swedish national registry, SWEDEHEART. Method: From 2008 to 2014 we identified 23,800 STEMI patients presenting within 12 hours from symptom onset treated with PPCI and UFH ± GPI or bivalirudin±GPI. Primary outcomes included 30-day all-cause mortality and major in-hospital bleeding. Multivariable regression models and propensity score modelling were utilized to study adjusted association between treatment and outcome. Results: Treatment with UFH ± GPI was associated with similar risk of 30-day mortality compared to bivalirudin±GPI (5.3% vs 5.5%, adjusted HR 0.94; 95% CI 0.82–1.07). The adjusted risk for 1-year mortality, 30-day and 1-year stent thrombosis and re-infarction did not differ significantly between UFH ± GPI and bivalirudin±GPI. In contrast, treatment with UFH ± GPI was associated with a significant higher risk of major in-hospital bleeding (adjusted OR 1.62; 95% CI 1.30–2.03). When including GPI use in the multivariable analysis, the difference was attenuated and no longer significant (adjusted OR 1.25; 95% CI 0.92–1.70). Conclusion: Bivalirudin±GPI was associated with significantly lower risk for major inhospital bleeding but no significant difference in 30-day or one year mortality, stent thrombosis or re-infarction compared with UFH ± GPI. The bleeding reduction associated with bivalirudin could be explained by the greater GPI use with UFH.
(Less)
- author
- Venetsanos, Dimitrios
; Lawesson, Sofia Sederholm
; James, Stefan
; Koul, Sasha
LU
; Erlinge, David
LU
; Swahn, Eva
and Alfredsson, Joakim
- organization
- publishing date
- 2018-07-01
- type
- Contribution to journal
- publication status
- published
- subject
- in
- American Heart Journal
- volume
- 201
- pages
- 8 pages
- publisher
- Mosby-Elsevier
- external identifiers
-
- scopus:85046083385
- pmid:29910059
- ISSN
- 0002-8703
- DOI
- 10.1016/j.ahj.2018.03.014
- language
- English
- LU publication?
- yes
- id
- 692101ce-0e62-45f9-87a1-670e15e70a2e
- date added to LUP
- 2018-05-07 13:46:34
- date last changed
- 2024-03-18 09:19:18
@article{692101ce-0e62-45f9-87a1-670e15e70a2e,
abstract = {{<p>Background: Optimal adjunctive therapy in ST-segment elevation myocardial infarction (STEMI) patients treated with primary PCI (PPCI) remains a matter of debate. Our aim was to compare the efficacy and safety of bivalirudin to unfractionated heparin (UFH), with or without glycoprotein IIb/IIIa inhibitors (GPI) in a large real-world population, using data from the Swedish national registry, SWEDEHEART. Method: From 2008 to 2014 we identified 23,800 STEMI patients presenting within 12 hours from symptom onset treated with PPCI and UFH ± GPI or bivalirudin±GPI. Primary outcomes included 30-day all-cause mortality and major in-hospital bleeding. Multivariable regression models and propensity score modelling were utilized to study adjusted association between treatment and outcome. Results: Treatment with UFH ± GPI was associated with similar risk of 30-day mortality compared to bivalirudin±GPI (5.3% vs 5.5%, adjusted HR 0.94; 95% CI 0.82–1.07). The adjusted risk for 1-year mortality, 30-day and 1-year stent thrombosis and re-infarction did not differ significantly between UFH ± GPI and bivalirudin±GPI. In contrast, treatment with UFH ± GPI was associated with a significant higher risk of major in-hospital bleeding (adjusted OR 1.62; 95% CI 1.30–2.03). When including GPI use in the multivariable analysis, the difference was attenuated and no longer significant (adjusted OR 1.25; 95% CI 0.92–1.70). Conclusion: Bivalirudin±GPI was associated with significantly lower risk for major inhospital bleeding but no significant difference in 30-day or one year mortality, stent thrombosis or re-infarction compared with UFH ± GPI. The bleeding reduction associated with bivalirudin could be explained by the greater GPI use with UFH.</p>}},
author = {{Venetsanos, Dimitrios and Lawesson, Sofia Sederholm and James, Stefan and Koul, Sasha and Erlinge, David and Swahn, Eva and Alfredsson, Joakim}},
issn = {{0002-8703}},
language = {{eng}},
month = {{07}},
pages = {{9--16}},
publisher = {{Mosby-Elsevier}},
series = {{American Heart Journal}},
title = {{Bivalirudin versus heparin with primary percutaneous coronary intervention}},
url = {{http://dx.doi.org/10.1016/j.ahj.2018.03.014}},
doi = {{10.1016/j.ahj.2018.03.014}},
volume = {{201}},
year = {{2018}},
}