Analysis of Randomized Trials Compares Bivalirudin vs. Heparin in AMI Patients

Bivalirudin use in STEMI patients undergoing primary PCI was associated with reductions in the 30-day rates of mortality, serious bleeding and net adverse clinical events (NACE) compared with heparin, based on late-breaking clinical science findings presented Oct. 14 during TCT 2020. However, patients taking heparin had lower rates of myocardial infarction (MI) and stent thrombosis compared with those taking bivalirudin.

Gregg W. Stone, MD, FACC, et al., conducted a systematic review of all randomized clinical trials (RCTs) in which ≥1,000 patients with acute MI undergoing PCI were assigned to bivalirudin or heparin. Of the 29 RCTs considered for inclusion, eight were selected for pooled analysis (ACUITY, BRIGHT, EUROMAX, HEAT-PPCI, HORIZONS-AMI, ISAR-REACT 4, MATRIX, and VALIDATE-SWEDEHEART).

In addition to reduced rates of mortality, serious bleeding and NACE, researchers noted the mortality benefit of bivalirudin in STEMI was pronounced in patients treated with a post-PCI bivalirudin infusion (low-dose or high-dose). A high-dose infusion mitigated the MI and stent thrombosis risk. In patients with NSTEMI undergoing PCI, bivalirudin use was associated with a reduction in the 30-day rate of serious bleeding but similar rates of mortality, MI, and stent thrombosis compared with heparin.

Keywords: TCT20, Transcatheter Cardiovascular Therapeutics, Myocardial Infarction, Percutaneous Coronary Intervention


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