Improved 30-day clinical outcomes, reduced risk of bleeding; but, risk of acute stent thrombosis up
WEDNESDAY, Oct. 30 (HealthDay News) -- For patients with ST-segment elevation myocardial infarction (STEMI) who are being transported for primary percutaneous coronary intervention (PCI), bivalirudin improves 30-day clinical outcomes, according to a study published online Oct. 30 in the New England Journal of Medicine. The research was published to coincide with the Transcatheter Cardiovascular Therapeutics conference, held from Oct. 27 to Nov. 1 in San Francisco.
Philippe Gabriel Steg, M.D., from the Université Paris-Diderot, and colleagues randomized 2,218 patients with STEMI who were being transported for primary PCI to receive bivalirudin or unfractionated or low-molecular weight heparin with optional glycoprotein IIb/IIIa inhibitors (control).
The researchers found that the risk of the primary outcome (30-day composite of death or major bleeding not associated with coronary artery bypass grafting [CABG]) was significantly reduced with bivalirudin versus control (5.1 versus 8.5 percent; relative risk, 0.60). The risk of the principal secondary outcome (composite of death, reinfarction, or non-CABG major bleeding) was also significantly reduced with bivalirudin versus control (6.6 versus 9.2 percent; relative risk, 0.72). Bivalirudin correlated with a reduced risk of major bleeding (relative risk, 0.43), but the risk of acute stent thrombosis was significantly increased (relative risk, 6.11). The rates of death or reinfarction were not significantly different between the groups.
"Bivalirudin, started during transport for primary PCI, improved 30-day clinical outcomes with a reduction in major bleeding but with an increase in acute stent thrombosis," the authors write.
The study was supported by the Medicines Company.
Abstract (http://www.nejm.org/doi/full/10.1056/NEJMoa1311096?query=featured_home#t=abstract )Full Text (http://www.nejm.org/doi/full/10.1056/NEJMoa1311096?query=featured_home#t=article )Editorial (http://www.nejm.org/doi/full/10.1056/NEJMe1312702?query=featured_home )More Information (http://www.tctconference.com )