The safety of a bivalirudin-based approach in patients undergoing rotational atherectomy.
BACKGROUND
Rotational atherectomy is associated with a high incidence of periprocedural myonecrosis. Glycoprotein (GP) IIb/IIIa inhibitors have been demonstrated to be particularly effective in this population in reducing periprocedural myocardial infarction. While bivalirudin-based therapy has emerged as an attractive alternative to heparin in patients undergoing contemporary percutaneous coronary intervention, it is unclear if such a strategy is safe in patients undergoing rotational atherectomy.


METHODS
We analyzed all patients undergoing rotational atherectomy at our institution from 2001 to 2004, and compared periprocedural outcome among those treated with a bivalirudin-based regimen compared to those treated with a heparin-based regimen.


RESULTS
A total of 253 patients were treated with rotational atherectomy during this period. Bivalirudin-based therapy was used in 56 patients, while the remainder were treated with a heparin-based approach. Patients treated with heparin were significantly more likely to be treated with GP IIb/IIIa inhibitors (91% vs 25%; p = 0.001). There was no difference in the two groups with respect to gender, diabetes, peripheral vascular disease or incidence of renal dysfunction. While there was no statistical difference in the incidence of any myonecrosis (32% versus 34%; p = 0.87), the incidence of creatine kinase-MB was greater than 3 times the upper limit of normal (ULN) (14.1% versus 5.7%; p = 0.15), or CK-MB >5 times the ULN (7.3% versus 1.9%) was nonsignificantly lower in the group treated with bivalirudin.


CONCLUSIONS
Bivalirudin-based therapy can be safely used in selected patients undergoing rotational atherectomy. Further studies are warranted to confirm our findings.
Gurm
Hitinder S
HS
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan 48109-0311, USA. hgurm@med.umich.edu
Rajagopal
Vivek
V
Bhatt
Deepak L
DL
Ellis
Stephen G
SG
Lincoff
A Michael
AM
D000368:Aged; D000369:Aged, 80 and over; D017225:Atherectomy, Coronary / Q000009:adverse effects / Q000379:methods*; D023903:Coronary Restenosis / Q000517:prevention & control*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use*; D006629:Hirudins; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D011859:Radiography; D011994:Recombinant Proteins / Q000627:therapeutic use; D012042:Registries; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
D006629:Hirudins; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin