Key result
Bivalirudin during primary PCI in older STEMI patients is linked to ~30% fewer adverse events versus unfractionated heparin.
Why the study?
STEMI is the most serious acute coronary syndrome, and the efficacy and safety of bivalirudin during PPCI in older patients with acute STEMI needed investigation.
Does bivalirudin reduce 30-day net adverse clinical events compared to unfractionated heparin in older patients (>75 years) with acute STEMI undergoing primary PCI?
Cohort (n=672)
Does bivalirudin reduce 30-day net adverse clinical events compared to unfractionated heparin in older patients (>75 years) with acute STEMI undergoing primary PCI?
In older patients (>75 years) with STEMI undergoing primary PCI, bivalirudin significantly reduces 30-day net adverse clinical events and bleeding compared to unfractionated heparin without increasing ischemic risks.
Answers are grounded in this paper and cite their sources.
Bivalirudin was associated with fewer 30-day NACEs in older STEMI patients; leaves open whether it should replace heparin pending randomized trials.
OBJECTIVE: ST-segment elevation myocardial infarction (STEMI) is the most serious type of acute coronary syndrome. This study aimed to investigate the efficacy and safety of bivalirudin application during primary percutaneous coronary intervention (PPCI) in older patients with acute STEMI. METHODS: A total of 672 older patients with STEMI (>75 years) who underwent PPCI were studied. The primary endpoints were 30-day net adverse clinical events (NACEs) post-emergency percutaneous coronary intervention, including major adverse cardiac and cerebrovascular events (MACCEs) and Bleeding Academic Research Consortium grades 2 to 5 (BARC 2-5) bleeding events. RESULTS: The incidence of NACEs and BARC 2-5 bleeding events in the bivalirudin group was significantly lower than that in the unfractionated heparin group. Multivariate Cox regression analysis showed that bivalirudin significantly reduced 30-day NACEs (odds ratio: 0.700, 95% confidence interval: 0.492-0.995) and BARC 2-5 bleeding events (odds ratio: 0.561, 95% confidence interval: 0.343-0.918). At 1-year follow-up, these results were similar. CONCLUSIONS: Bivalirudin can be safely and effectively used during PPCI in older patients with STEMI. Bivalirudin reduces the risks of NACEs and bleeding within 30 days after PPCI, without increasing the risks of MACCEs and stent thrombosis compared with heparin.
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Chen et al. (2020) conducted a cohort in Acute ST-segment elevation myocardial infarction (STEMI) (n=672). Bivalirudin vs. Unfractionated heparin was evaluated on 30-day net adverse clinical events (NACEs) post-emergency percutaneous coronary intervention (OR 0.700, 95% CI 0.492-0.995). Bivalirudin during primary PCI in older patients with STEMI significantly reduced 30-day net adverse clinical events compared to unfractionated heparin (OR 0.700; 95% CI 0.492-0.995).
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