In-Hospital Outcome Comparing Bivalirudin to Heparin in Real-World Primary Percutaneous Coronary Intervention.

Autor: Hasun M; 2nd Medical Department with Cardiology and Intensive Care Medicine, KA Rudolfstiftung, Vienna, Austria., Dörler J; Department of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria., Edlinger M; Department of Medical Statistics, Informatics, and Health Economics, Medical University Innsbruck, Innsbruck, Austria., Alber H; Department of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria., Von Lewinski D; Department of Internal Medicine, Cardiology, Medical University Graz, Graz, Austria., Eber B; Department of Internal Medicine II-Cardiology, Intensive Care Medicine, Klinikum Wels-Grieskirchen GmbH, Wels, Austria., Roithinger FX; Department of Internal Medicine, Landesklinikum Baden-Mödling, Mödling, Austria., Berger R; Department of Internal Medicine I, Krankenhaus der Barmherzigen Brüder Eisenstadt, Eisenstadt, Austria., Siostrzonek P; Department of Internal Medicine II: Cardiology, Krankenhaus Barmherzige Schwestern Linz, Linz, Austria., Grimm G; 2nd Medical Department, Cardiology and Internal Intensive Care Medicine, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria., Benzer W; Department of Internal Medicine, Interventional Cardiology, LKH Feldkirch, Feldkirch, Austria., Wintersteller W; Department of Internal Medicine II, Cardiology and Internal Intensive Care Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria., Huber K; 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenspital, Vienna, Austria., Schuchlenz H; Department of Cardiology and Intensive Care Medicine, LKH Graz West, Graz, Austria., Weidinger F; 2nd Medical Department with Cardiology and Intensive Care Medicine, KA Rudolfstiftung, Vienna, Austria. Electronic address: franz.weidinger@wienkav.at.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2017 Dec 15; Vol. 120 (12), pp. 2135-2140. Date of Electronic Publication: 2017 Sep 20.
DOI: 10.1016/j.amjcard.2017.08.037
Abstrakt: Randomized controlled trials have shown conflicting results regarding the outcome of bivalirudin in primary percutaneous coronary intervention (PPCI). The aim of this study was to evaluate the in-hospital outcomes of patients receiving heparin or bivalirudin in a real-world setting of PPCI: 7,023 consecutive patients enrolled in the Austrian Acute PCI Registry were included between January 2010 and December 2014. Patients were classified according to the peri-interventional anticoagulation regimen receiving heparin (n = 6430) or bivalirudin (n = 593) with or without GpIIb/IIIa inhibitors (GPIs). In-hospital mortality (odds ratio [OR] 1.13, 95% confidence interval [CI] 0.57 to 2.25, p = 0.72), major adverse cardiovascular events (OR 1.18, 95% CI 0.65 to 2.14, p = 0.59), net adverse clinical events (OR 1.01, 95% CI 0.57 to 1.77, p = 0.99), and TIMI non-coronary artery bypass graft-related major bleeding (OR 0.41, 95% CI 0.09 to 1.86, p = 0.25) were not significantly different between the groups. However, we detected potential effect modifications of anticoagulants on mortality by GPIs (OR 0.12, 95% CI 0.01 to 1.07, p = 0.06) and access site (OR 0.25, 95% CI 0.06 to 1.03, p = 0.06) favoring bivalirudin in femoral access. In conclusion, this large real-world cohort of PPCI, heparin-based anticoagulation showed similar results of short-term mortality compared with bivalirudin. We observed a potential effect modification by additional GPI use and access favoring bivalirudin over heparin in femoral, but not radial, access.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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