Direct thrombin inhibitors in acute coronary syndromes: effect in patients undergoing early percutaneous coronary intervention.
OBJECTIVE
We evaluated the effect of direct thrombin inhibitors (DTIs) in patients undergoing early percutaneous coronary intervention (PCI), using the DTI Trialists' Collaboration database of 35,970 patients from 11 randomized trials of DTIs vs. heparin.


RESULTS
We performed a Cox proportional hazards regression analysis with PCI as a time-dependent covariate to assess the independent impact of DTIs according to the performance of early PCI. PCI was performed in 7049 patients in the first 72 h after randomization. In trials in which PCI was not planned, DTIs were associated with a 10% relative risk reduction in death or myocardial infarction at 30 days (HR=0.90, 95% CI: 0.84-0.97). This benefit was found to be greater in patients undergoing early PCI (HR=0.66, 95% CI: 0.48-0.91) than those undergoing non-early PCI (HR=0.94, 95% CI: 0.86-1.03). After adjustment for baseline characteristics and propensity to undergo PCI, the risk of death or myocardial infarction remained lower with DTI (HR=0.62, 95% CI: 0.44-0.89).


CONCLUSIONS
After adjustment for baseline differences and propensity to undergo early PCI, DTIs appeared to be more effective than heparin in reducing death or re-infarction among patients undergoing early PCI.
Sinnaeve
Peter R
PR
Duke Clinical Research Center, Durham, NC, USA. peter.sinnaeve@uz.kuleuven.ac.be
Simes
John
J
Yusuf
Salim
S
Garg
Jyotsna
J
Mehta
Shamir
S
Eikelboom
John
J
Bittl
John A
JA
Serruys
Patrick
P
Topol
Eric J
EJ
Granger
Christopher B
CB
D000208:Acute Disease; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000925:Anticoagulants / Q000627:therapeutic use; D000991:Antithrombins / Q000627:therapeutic use*; D003327:Coronary Disease / Q000628:therapy*; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D013577:Syndrome; D013917:Thrombin / Q000037:antagonists & inhibitors*; D016896:Treatment Outcome
D000925:Anticoagulants; D000991:Antithrombins; D006493:Heparin; D013917:Thrombin