title: Intracoronary vs intravenous bivalirudin bolus in ST-elevation myocardial infarction patients treated with primary angioplasty.
abstract: BACKGROUND
  Intracoronary bolus administration may provide high local bivalirudin concentration without changing the global dose, potentially offering a more favorable antithrombotic effect in the infarct related artery (IRA).
  
  
  OBJECTIVE
  The purpose of this study was to investigate the feasibility and safety of intracoronary bolus administration of bivalirudin followed by the standard intravenous infusion in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
  
  
  METHODS
  In 245 consecutive patients treated with primary PCI, bivalirudin bolus was given directly in the IRA, followed by a standard intravenous infusion. Clinical reperfusion markers, postprocedural coronary flow indexes, and bleeding events of the intracoronary group were compared with a propensity score-matched cohort of primary PCI patients (n=245) treated with the standard bivalirudin protocol of intravenous bolus and infusion.
  
  
  RESULTS
  Higher rates of ⩾70% ST-segment resolution (72.7% vs 60.0%, p=0.004), lower postprocedural peak CK-MB levels (188.3±148.7 vs 242.1±208.1 IU/dl, p=0.025) and better Thrombolysis in Myocardial Infarction (TIMI) frame count values (14.7 vs 17.9, p=0.001) were observed in the IC bolus group compared with the standard intravenous bolus group. Rates of bleeding were similar between groups. Only three cases of acute stent thrombosis were observed, all in the intravenous bolus group (p=0.25).
  
  
  CONCLUSIONS
  Intracoronary bivalirudin bolus administration during primary PCI is safe and improves ST-segment resolution, postprocedural coronary flow and enzymatic infarct size compared with the standard intravenous route.
authors.affiliation: 2nd Division of Cardiology, "Maggiore della Carità" University Hospital, Italy lupialessandro1@tin.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Lupi
authors.affiliation: 2nd Division of Cardiology, "Maggiore della Carità" University Hospital, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rognoni
authors.affiliation: Divisione di Cardiologia, Ospedale S. Andrea, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Cavallino
authors.affiliation: 2nd Division of Cardiology, "Maggiore della Carità" University Hospital, Italy.
authors.forename: Gioel G
authors.initials: GG
authors.lastname: Secco
authors.affiliation: Divisione di Cardiologia, Ospedale S. Andrea, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Reale
authors.affiliation: Divisione di Cardiologia, Ospedale S. Andrea, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cossa
authors.affiliation: 2nd Division of Cardiology, "Maggiore della Carità" University Hospital, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Rosso
authors.affiliation: 2nd Division of Cardiology, "Maggiore della Carità" University Hospital, Italy.
authors.forename: Angelo S
authors.initials: AS
authors.lastname: Bongo
authors.affiliation: Cardiologia Interventistica, A.O. Fatebenefratelli, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Cortese
authors.affiliation: University of Florida College of Medicine-Jacksonville, USA.
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, USA.
authors.forename: Allan S
authors.initials: AS
authors.lastname: Jaffe
authors.affiliation: Istitute of Cardiology, UCSC, Italy.
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D006629:Hirudins / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000008:administration & dosage*; D062645:Percutaneous Coronary Intervention; D011994:Recombinant Proteins / Q000008:administration & dosage; D000072657:ST Elevation Myocardial Infarction / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin
keywords: Bivalirudin; ST-segment elevation myocardial infarction; intracoronary; primary percutaneous coronary intervention; stent thrombosis