title: Effect of postprocedural full-dose infusion of bivalirudin on acute stent thrombosis in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: Outcomes in a large real-world population.
abstract: OBJECTIVE
  This study aimed to evaluate the effect of prolonged full-dose bivalirudin infusion in real-world population with ST-elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  Subgroup data as well as meta-analysis from randomized clinical trials have shown the potency of postprocedural full-dose infusion (1.75 mg/kg/h) of bivalirudin on attenuating acute stent thrombosis (ST) after primary percutaneous coronary intervention (PCI).
  
  
  METHODS
  In this multicenter retrospective observational study, 2047 consecutive STEMI patients treated with bivalirudin during primary PCI were enrolled in 65 Chinese centers between July 2013 and May 2016. The primary outcome was acute ST defined as ARC definite/probable within 24 hours after the index procedure, and the secondary endpoints included total ST, major adverse cardiac or cerebral events (MACCE, defined as death, reinfarction, stroke, and target vessel revascularization), and any bleeding at 30 days.
  
  
  RESULTS
  Among 2047 STEMI patients, 1123 (54.9%) were treated with postprocedural bivalirudin full-dose infusion (median 120 minutes) while the other 924 (45.1%) received low-dose (0.25 mg/kg/h) or null postprocedural infusion. A total of three acute ST (0.3%) occurred in STEMI patients with none or low-dose prolonged infusion of bivalirudin, but none was observed in those treated with post-PCI full-dose infusion (0.3% vs 0.0%, P=.092). Outcomes on MACCE (2.1% vs 2.7%, P=.402) and total bleeding (2.1% vs 1.4%, P=.217) at 30 days showed no significant difference between the two groups, and no subacute ST was observed.
  
  
  CONCLUSIONS
  Post-PCI full-dose bivalirudin infusion is safe and has a trend to protect against acute ST in STEMI patients undergoing primary PCI in real-world settings.
authors.affiliation: General Hospital of Shenyang Military Region, Shenyang, China.
authors.forename: Heyang
authors.identifier: http://orcid.org/0000-0001-6651-1901
authors.initials: H
authors.lastname: Wang
authors.affiliation: General Hospital of Shenyang Military Region, Shenyang, China.
authors.forename: Zhenyang
authors.initials: Z
authors.lastname: Liang
authors.affiliation: General Hospital of Shenyang Military Region, Shenyang, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.affiliation: Hainan General Hospital, Haikou, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Li
authors.affiliation: Xinjiang Corps General Hospital, Urumchi, China.
authors.forename: Junming
authors.initials: J
authors.lastname: Liu
authors.affiliation: Beijing Shijingshan Hospital, Beijing, China.
authors.forename: Xueyi
authors.initials: X
authors.lastname: Hong
authors.affiliation: Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Lu
authors.affiliation: Shenzhen Forth Hospital, Shenzhen, China.
authors.forename: Jiansheng
authors.initials: J
authors.lastname: Wu
authors.affiliation: Tianjin Chest Hospital, Tianjin, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhao
authors.affiliation: Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Shanxi Cardiovascular Hospital, Taiyuan, China.
authors.forename: Jian
authors.initials: J
authors.lastname: An
authors.affiliation: Jiangxi Province People's Hospital, Nanchang, China.
authors.forename: Linfeng
authors.initials: L
authors.lastname: Li
authors.affiliation: Dongying People's Hospital, Dongying, China.
authors.forename: Fanli
authors.initials: F
authors.lastname: Pu
authors.affiliation: Shanghai Tenth People's Hospital, Shanghai, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Ming
authors.affiliation: General Hospital of Shenyang Military Region, Shenyang, China.
authors.forename: Yaling
authors.initials: Y
authors.lastname: Han
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000008:administration & dosage* / Q000009:adverse effects; D002681:China; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006629:Hirudins / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000008:administration & dosage* / Q000009:adverse effects; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin
keywords: Acute stent thrombosis; Bivalirudin; Primary percutaneous coronary intervention; ST-elevation myocardial infarction