Heparin versus bivalirudin for non‐primary percutaneous coronary intervention: A post‐Hoc analysis of the CPORT‐E trial. Issue 3 (4th February 2017)

• Record Type: Journal Article
• Authors: Czarny, Matthew J.; Hwang, Chao‐Wei; Naiman, Daniel Q.; Lemmon, Cynthia C.; Hasan, Rani K.; Wang, Thomas; Aversano, Thomas
• Is Part Of: Catheterization and cardiovascular interventions. Volume 90:Issue 3(2017)
• Page Start: 366
• Page End: 377
• Publication Date: 2017-02-04
• Subjects: anticoagulation -- catheterization -- intervention; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.26953
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract : Objectives: To compare bivalirudin to heparin during non‐primary percutaneous coronary intervention (PCI). Background: The optimal anticoagulant to support PCI remains uncertain. Methods: We performed a propensity score‐based analysis comparing clinical outcomes of patients receiving heparin to those receiving bivalirudin during non‐primary PCI. Results: Of 18, 867 patients in the Cardiovascular Patient Outcomes Research Team Non‐Primary PCI (CPORT‐E) trial, we selected 7, 913 patients undergoing non‐staged PCI of whom 57.3% received heparin and 42.7% received bivalirudin. In‐hospital myocardial infarction occurred in 4.4% of patients receiving bivalirudin and 3.0% of patients receiving heparin (relative risk [RR] 1.5, 95% confidence interval [CI] 1.1–2.1, P = 0.022); this difference persisted at 6 weeks (5.0% vs. 3.6%, RR 1.4, 95% CI 1.0–1.8, P = 0.041). There was no difference in all‐cause mortality either in‐hospital (0.2% vs. 0.1% for heparin vs. bivalirudin, P = 0.887) or at 6 weeks (0.5% vs. 0.7%, P = 0.567). In‐hospital bleeding requiring transfusion occurred in 0.9% of patients receiving bivalirudin and 1.9% of patients receiving heparin (RR 0.4, 95% CI 0.3–0.7, P <0.001), but there was no difference at 6 weeks (2.7% for heparin vs. 1.9% for bivalirudin, RR 0.7, 95% CI 0.5–1.0, P = 0.062). Conclusions: In patients undergoing non‐primary PCI at hospitals without on‐site cardiac surgery, bivalirudin was associated with a decreased risk of in‐hospital bleeding requiring transfusion and an increased risk of in‐hospital MI compared to heparin. © 2017 Wiley Periodicals, Inc.