title: Statin effect on thrombin inhibitor effectiveness during percutaneous coronary intervention: a post-hoc analysis from the ISAR-REACT 3 trial.
abstract: OBJECTIVE
  To determine whether statin therapy influences the efficacy of thrombin inhibitor bivalirudin or unfractionated heparin (UFH) during PCI.
  
  
  METHODS
  The post-hoc analysis of the ISAR-REACT 3 Trial included 4,570 patients: 3,106 patients were on statin therapy and 1,464 patients were not on statin therapy at the time of PCI procedure.
  
  
  METHODS
  The primary outcome of this analysis was the 30-day composite of death, myocardial infarction, target vessel revascularization (TVR) or major bleeding.
  
  
  RESULTS
  The primary outcome occurred in 7.9% patients (n = 246) in the statin group versus 9.8% (n = 143) in the non-statin group (P = 0.036). There was an interaction in univariate (P = 0.028) and multivariable (P = 0.026) analysis between pre-PCI statin therapy and the type of antithrombotic therapy regarding myocardial infarction. In the statin group, bivalirudin significantly reduced the incidence of major bleeding (2.6 vs. 4.3%, P = 0.013) with no significant difference in the incidence of myocardial infarction (4.9 vs. 5.2%; P = 0.73) compared with UFH. In the non-statin group, bivalirudin was inferior to UFH regarding the incidence of myocardial infarction (7.1 vs. 4.1%, P = 0.013), yet major bleeding remained lower among bivalirudin-treated patients (4.0 vs. 5.2%, P = 0.25).
  
  
  CONCLUSIONS
  This post-hoc analysis suggests the existence of an interaction between statin therapy before PCI and antithrombotic therapy during PCI. Patients receiving bivalirudin therapy at the time of PCI showed less periprocedural myocardial infarction when on pre-PCI statin therapy which has to be investigated in further studies.
authors.affiliation: Herz-Kreislauf-Zentrum, Segeberger Kliniken GmbH, Bad Segeberg, Germany. ahmed.khattab@insel.ch
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khattab
authors.forename: Gjin
authors.initials: G
authors.lastname: Ndrepepa
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schulz
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
authors.forename: Julinda
authors.initials: J
authors.lastname: Mehilli
authors.forename: Heinz Joachim
authors.initials: HJ
authors.lastname: Büttner
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pache
authors.forename: Melchior
authors.initials: M
authors.lastname: Seyfarth
authors.forename: Josef
authors.initials: J
authors.lastname: Dirschinger
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
authors.forename: Albert
authors.initials: A
authors.lastname: Schömig
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000991:Antithrombins / Q000009:adverse effects / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D004347:Drug Interactions; D005260:Female; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006629:Hirudins / Q000009:adverse effects / Q000187:drug effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000009:adverse effects / Q000187:drug effects / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000009:adverse effects / Q000187:drug effects / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D006629:Hirudins; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin