Comparison of bivalirudin with heparin versus abciximab with heparin for primary percutaneous coronary intervention in 'Real World' practice

Autor: Gerald J. Clesham, John R. Davies, Paul A. Kelly, Mike Parker, Wasing Taggu, Kare H. Tang, Reto Gamma, Rajesh K. Aggarwal, Jeremy Sayer, Refai Showkathali
Rok vydání: 2013
Předmět:
Male
medicine.medical_specialty
Time Factors
Abciximab
medicine.medical_treatment
Myocardial Infarction
Hemorrhage
Kaplan-Meier Estimate
Platelet Glycoprotein GPIIb-IIIa Complex
Antithrombins
Immunoglobulin Fab Fragments
Percutaneous Coronary Intervention
Risk Factors
Internal medicine
medicine
Humans
Bivalirudin
Hospital Mortality
Aged
Proportional Hazards Models
Retrospective Studies
Heparin
business.industry
Coronary Thrombosis
Cardiogenic shock
Significant difference
Antibodies
Monoclonal
Anticoagulants
Percutaneous coronary intervention
General Medicine
Hirudins
Middle Aged
Device use
medicine.disease
Peptide Fragments
Recombinant Proteins
Logistic Models
Treatment Outcome
Cardiology
Drug Therapy
Combination
Female
Cardiology and Cardiovascular Medicine
business
Platelet Aggregation Inhibitors
Major bleeding
medicine.drug
Zdroj: Cardiovascular Revascularization Medicine. 14:289-293
ISSN: 1553-8389
Popis: Objective We aimed to carry out a “real world” comparison of bivalirudin plus unfractionated heparin (UFH) versus abciximab plus UFH in patients undergoing primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI). Methods We included patients who had abciximab or bivalirudin during their PPCI in our unit between Sept 2009 and Nov 2011. Results The study included 516 and 484 patients in the bivalirudin and abciximab group respectively. There were more women in the bivalirudin group (29% vs 20%, p 0.001), while cardiogenic shock (6.4% vs 10.1%, p 0.04) and thrombectomy device use (76.6% vs 82%, p 0.04) were lower in the bivalirudin group. The primary composite end point of 30-day mortality, 30-day definite stent thrombosis or non-CABG major bleeding was similar between the bivalirudin and abciximab groups (7.8% vs 9.5%, OR 0.8, 95% CI 0.5 to 1.2, p 0.4). There was also no difference in in-hospital mortality (4.1% vs 4.3%, p 0.9), 30-day mortality (5.2% vs 6.4%, p 0.5), 1-year mortality (9.1% vs 9.9%, p 0.7), 30-day stent thrombosis (1% vs 0.4%, p 0.5) and non-CABG bleeding (2.7 vs 3.7%, p 0.4) between the bivalirudin and abciximab group respectively. On Cox proportional hazard analysis after adjusting for all the co-variates, the use of bivalirudin was not a predictor of 30-day mortality (HR 1.13, 95% CI 0.7–1.9, p 0.7). Conclusion In this “real-world” observational study, there was no significant difference in the clinical outcome of PPCI for patients who had abciximab or bivalirudin after initial pre-treatment with UFH.
Databáze: OpenAIRE
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