| Title: |
Bivalirudin Versus Heparin During PCI in NSTEMI: Individual Patient Data Meta-Analysis of Large Randomized Trials |
| Authors: |
Bikdeli, Behnood; Erlinge, David; Valgimigli, Marco; Kastrati, Adnan; Han, Yaling; Steg, Philippe Gabriel; Stables, Rod H.; Mehran, Roxana; James, Stefan K.; Frigoli, Enrico; Goldstein, Patrick; Li, Yi; Shahzad, Adeel; Schüpke, Stefanie; Mehdipoor, Ghazaleh; Chen, Shmuel; Redfors, Björn; Crowley, Aaron; Zhou, Zhipeng; Stone, Gregg W. |
| Source: |
Circulation ; volume 148, issue 16, page 1207-1219 ; ISSN 0009-7322 1524-4539 |
| Publisher Information: |
Ovid Technologies (Wolters Kluwer Health) |
| Publication Year: |
2023 |
| Description: |
BACKGROUND: The benefit:risk profile of bivalirudin versus heparin anticoagulation in patients with non–ST-segment–elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) is uncertain. Study-level meta-analyses lack granularity to provide conclusive answers. We sought to compare the outcomes of bivalirudin and heparin in patients with non–ST-segment–elevation myocardial infarction undergoing PCI. METHODS: We performed an individual patient data meta-analysis of patients with non–ST-segment–elevation myocardial infarction in all 5 trials that randomized ≥1000 patients with any myocardial infarction undergoing PCI to bivalirudin versus heparin (MATRIX [Minimizing Adverse Hemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox], VALIDATE-SWEDEHEART [Bivalirudin Versus Heparin in ST-Segment and Non–ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies Registry Trial], ISAR-REACT 4 [Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 4], ACUITY [Acute Catheterization and Urgent Intervention Triage Strategy], and BRIGHT [Bivalirudin in Acute Myocardial Infarction vs Heparin and GPI Plus Heparin Trial]). The primary effectiveness and safety end points were 30-day all-cause mortality and serious bleeding. RESULTS: A total of 12 155 patients were randomized: 6040 to bivalirudin (52.3% with a post-PCI bivalirudin infusion), and 6115 to heparin (53.2% with planned glycoprotein IIb/IIIa inhibitor use). Thirty-day mortality was not significantly different between bivalirudin and heparin (1.2% versus 1.1%; adjusted odds ratio, 1.24 [95% CI, 0.86–1.79]; P =0.25). Cardiac mortality, reinfarction, and stent thrombosis rates were also not significantly different. Bivalirudin reduced serious bleeding (both access site–related and non—access site–related) compared ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1161/circulationaha.123.063946 |
| DOI: |
10.1161/CIRCULATIONAHA.123.063946 |
| Availability: |
https://doi.org/10.1161/circulationaha.123.063946; https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.123.063946 |
| Accession Number: |
edsbas.9D5C8908 |
| Database: |
BASE |