title: Anticoagulation with bivalirudin during percutaneous coronary intervention for ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  The objective of this retrospective analysis of high-risk patients treated with bivalirudin during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) was to evaluate the safety and feasibility of direct thrombin inhibitor (DTI) without concomitant glycoprotein (GP) IIb/IIIa inhibition.
  
  
  BACKGROUND
  Reperfusion by PCI is the treatment of choice for patients with STEMI. In patients with stable or unstable angina without ST-segment elevation undergoing PCI, bivalirudin was at least as effective as heparin plus GPIIb/IIIa inhibitors in reducing ischemic events and more effective in preventing bleeding. There are no published studies detailing the use of bivalirudin in patients with STEMI.
  
  
  METHODS
  From 09/02 to 05/03 at the Heart Care Centers of Illinois, Blue Island, Illinois. Ninety-one consecutive patients with STEMI underwent PCI with or without stent placement. Bivalirudin was administered as a bolus dose (0.75 mg/kg) followed by infusion (1.75 mg/kg/hr) for the duration of the procedure. Outcomes were recorded over a 30-day follow-up period.
  
  
  RESULTS
  Patients (n = 91) had several high-risk characteristics (40% female, 30% diabetes mellitus, 21% previous MI and 18% cardiogenic shock). PCI procedures utilized balloons, stents, or a combination of both. Intraaortic balloon pumps were used for 41% and closure devices for 24% of patients.
  
  
  CONCLUSIONS
  This evaluation demonstrates excellent TIMI flow without the addition of GPIIb/IIIa inhibitors. The low mortality and complication rates suggest anticoagulation with bivalirudin in patients with STEMI undergoing PCI is feasible and warrants further study in larger controlled trials to evaluate the effectiveness of bivalirudin in this patient population.
authors.affiliation: Heart Care Centers of Illinois, Interventional Cardiology Division, 2338 New Street, Blue Island, IL, 60406, USA. jstella@heartcc.com
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Stella
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Stella
authors.forename: Robert A
authors.initials: RA
authors.lastname: Iaffaldano
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Stella
authors.forename: Kurt W
authors.initials: KW
authors.lastname: Erickson
authors.forename: Roy C
authors.initials: RC
authors.lastname: Bliley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use*; D000991:Antithrombins / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006629:Hirudins / Q000031:analogs & derivatives*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000628:therapy; D010446:Peptide Fragments / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin