Open AccessEffect of postprocedural full‐dose infusion of bivalirudin on acute stent thrombosis in patients with ST ‐elevation myocardial infarction undergoing primary percutaneous coronary intervention: Outcomes in a large real‐world population
Author(s) -
Wang Heyang,
Liang Zhenyang,
Li Yi,
Li Bin,
Liu Junming,
Hong Xueyi,
Lu Xin,
Wu Jiansheng,
Zhao Wei,
Liu Qiang,
An Jian,
Li Linfeng,
Pu Fanli,
Ming Qiang,
Han Yaling
Publication year - 2017
Publication title -
cardiovascular therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.818
H-Index - 46
eISSN - 1755-5922
pISSN - 1755-5914
DOI - 10.1111/1755-5922.12251
Subject(s) - medicine , bivalirudin , conventional pci , percutaneous coronary intervention , myocardial infarction , cardiology , population , stroke (engine) , anesthesia , mechanical engineering , environmental health , engineering
Summary Aim This study aimed to evaluate the effect of prolonged full‐dose bivalirudin infusion in real‐world population with ST ‐elevation myocardial infarction ( STEMI ). Background Subgroup data as well as meta‐analysis from randomized clinical trials have shown the potency of postprocedural full‐dose infusion (1.75 mg/kg/h) of bivalirudin on attenuating acute stent thrombosis ( ST ) after primary percutaneous coronary intervention ( PCI ). Methods In this multicenter retrospective observational study, 2047 consecutive STEMI patients treated with bivalirudin during primary PCI were enrolled in 65 Chinese centers between July 2013 and May 2016. The primary outcome was acute ST defined as ARC definite/probable within 24 hours after the index procedure, and the secondary endpoints included total ST , major adverse cardiac or cerebral events ( MACCE , defined as death, reinfarction, stroke, and target vessel revascularization), and any bleeding at 30 days. Results Among 2047 STEMI patients, 1123 (54.9%) were treated with postprocedural bivalirudin full‐dose infusion (median 120 minutes) while the other 924 (45.1%) received low‐dose (0.25 mg/kg/h) or null postprocedural infusion. A total of three acute ST (0.3%) occurred in STEMI patients with none or low‐dose prolonged infusion of bivalirudin, but none was observed in those treated with post‐ PCI full‐dose infusion (0.3% vs 0.0%, P =.092). Outcomes on MACCE (2.1% vs 2.7%, P =.402) and total bleeding (2.1% vs 1.4%, P =.217) at 30 days showed no significant difference between the two groups, and no subacute ST was observed. Conclusion Post‐ PCI full‐dose bivalirudin infusion is safe and has a trend to protect against acute ST in STEMI patients undergoing primary PCI in real‐world settings.