title: Bivalirudin, glycoprotein inhibitor, and heparin use and association with outcomes of primary percutaneous coronary intervention in the United Kingdom.
abstract: The HORIZONS trial reported a survival advantage for bivalirudin over heparin-with-glycoprotein inhibitors (GPIs) in primary PCI for ST elevation myocardial infarction. This drove an international shift in clinical practice. Subsequent studies have produced divergent findings on mortality benefits with bivalirudin. We investigated this issue in a larger population than studied in any of these trials, using the United Kingdom national PCI registry.
  
  
  
  61 136 primary PCI procedures were performed between January 2008 and January 2012. Demographic and procedural data were obtained from the registry. Mortality information was obtained through the UK Office of National Statistics. Multivariable logistic regression and propensity analysis modelling were utilized to study the association of different anti-thrombotic strategies with outcomes. Unadjusted data demonstrated near-identical survival curves for bivalirudin and heparin-plus-GPI groups. Significantly higher early and late mortality was found in patients treated with heparin alone ( ITALIC! P < 0.0001) but this group had a markedly higher baseline risk. After propensity matching, the bivalirudin vs. heparin-plus-GPI groups still demonstrated very similar adjusted mortality (odds ratio 1.00 at 30 days, and 0.96 at 1 year). Patients treated with heparin alone continued to show higher mortality after adjustment, although effect size was considerably diminished (odds ratio vs. other groups 1.17-1.24 at 30 days).
  
  
  
  Analysis of recent UK data showed no significant difference in short- or medium-term mortality between ST elevation myocardial infarction patients treated with bivalirudin vs. heparin-plus-GPI at primary PCI.
authors.affiliation: University College London Hospitals and St. Bartholomew's Hospital, London, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Sirker
authors.affiliation: Keele University, Staffordshire, UK University of Manchester, Manchester, UK.
authors.forename: Mamas
authors.initials: M
authors.lastname: Mamas
authors.affiliation: University of Sussex, Brighton, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: Robinson
authors.affiliation: University of Manchester, Manchester, UK University of Oxford, Oxford, UK.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Anderson
authors.affiliation: University Hospital of Wales, Cardiff, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Kinnaird
authors.affiliation: Liverpool Heart and Chest Hospital, Merseyside, UK.
authors.forename: Rod
authors.initials: R
authors.lastname: Stables
authors.affiliation: The James Cook University Hospital, Middlesborough, UK.
authors.forename: Mark A
authors.initials: MA
authors.lastname: de Belder
authors.affiliation: Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Ludman
authors.affiliation: Brighton and Sussex University Hospitals, Brighton, UK david.hildick-smith@bsuh.nhs.uk.
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
mesh_terms: D000925:Anticoagulants; D006493:Heparin; D006629:Hirudins; D006801:Humans; D009203:Myocardial Infarction; D010446:Peptide Fragments; D062645:Percutaneous Coronary Intervention; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin
keywords: Anti-thrombotic; Bivalirudin; Glycoprotein inhibitor; Heparin; Primary PCI; STEMI