title: Effect of prolonged Bivalirudin infusion on ST-segment resolution following primary percutaneous coronary intervention (from the PROBI VIRI 2 study).
abstract: Bivalirudin is widely used as an anticoagulant during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction. However, an increase in acute stent thrombosis rates has been found in the HORIZONS-AMI trial. A prolonged infusion after PCI has been shown to be a safe and effective tool in patients undergoing urgent or elective PCI in the PROBI VIRI study. We examined the effects of prolonged drug infusion after primary PCI. From databases of 5 high-volume centers we compared a group of patients treated with a 4-hour prolonged infusion after PCI to 2 groups treated with a peri-PCI infusion and heparin plus abciximab. The primary study end point was >70% ST-segment resolution within 90 minutes after PCI; secondary end points were partial (>50%) ST-segment resolution within 90 minutes and intrahospital major and minor bleedings on the Acuity scale. The study population consisted of 264 patients undergoing primary PCI who were pretreated with aspirin and clopidogrel. The 3 study groups did not differ significantly by baseline characteristics. The primary end point was achieved in 69.8%, 48.8%, and 69.6% of patients in the prolonged bivalirudin, bivalirudin, and heparin/abciximab groups, respectively (p = 0.048 for prolonged vs standard infusion, p = 0.98 for prolonged infusion vs abciximab). Major bleedings and other secondary study end points were not significantly different among study groups. In conclusion, a strategy of prolonged bivalirudin infusion after primary PCI seems equivalent to a strategy with heparin plus abciximab, with an improvement in standard infusion in obtaining early microvascular reperfusion.
authors.affiliation: Interventional Cardiology, Cliniche Humanitas Gavazzeni, Bergamo, Italy. bcortese@gmail.com
authors.forename: Bernardo
authors.initials: B
authors.lastname: Cortese
authors.forename: Ugo
authors.initials: U
authors.lastname: Limbruno
authors.forename: Silva
authors.initials: S
authors.lastname: Severi
authors.forename: Sara
authors.initials: S
authors.lastname: De Matteis
authors.forename: Livia
authors.initials: L
authors.lastname: Diehl
authors.forename: Antonio
authors.initials: A
authors.lastname: Pitì
mesh_terms: D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D000925:Anticoagulants / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006493:Heparin / Q000008:administration & dosage; D006629:Hirudins / Q000008:administration & dosage*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010446:Peptide Fragments / Q000008:administration & dosage*; D011182:Postoperative Care; D011994:Recombinant Proteins / Q000008:administration & dosage
chemical_list: D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D006629:Hirudins; D007140:Immunoglobulin Fab Fragments; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin; D000077284:Abciximab