Heparin versus bivalirudin for non-primary percutaneous coronary intervention: A post-Hoc analysis of the CPORT-E trial.
OBJECTIVE
To compare bivalirudin to heparin during non-primary percutaneous coronary intervention (PCI).


BACKGROUND
The optimal anticoagulant to support PCI remains uncertain.


METHODS
We performed a propensity score-based analysis comparing clinical outcomes of patients receiving heparin to those receiving bivalirudin during non-primary PCI.


RESULTS
Of 18,867 patients in the Cardiovascular Patient Outcomes Research Team Non-Primary PCI (CPORT-E) trial, we selected 7,913 patients undergoing non-staged PCI of whom 57.3% received heparin and 42.7% received bivalirudin. In-hospital myocardial infarction occurred in 4.4% of patients receiving bivalirudin and 3.0% of patients receiving heparin (relative risk [RR] 1.5, 95% confidence interval [CI] 1.1-2.1, P = 0.022); this difference persisted at 6 weeks (5.0% vs. 3.6%, RR 1.4, 95% CI 1.0-1.8, P = 0.041). There was no difference in all-cause mortality either in-hospital (0.2% vs. 0.1% for heparin vs. bivalirudin, P = 0.887) or at 6 weeks (0.5% vs. 0.7%, P = 0.567). In-hospital bleeding requiring transfusion occurred in 0.9% of patients receiving bivalirudin and 1.9% of patients receiving heparin (RR 0.4, 95% CI 0.3-0.7, P <0.001), but there was no difference at 6 weeks (2.7% for heparin vs. 1.9% for bivalirudin, RR 0.7, 95% CI 0.5-1.0, P = 0.062).


CONCLUSIONS
In patients undergoing non-primary PCI at hospitals without on-site cardiac surgery, bivalirudin was associated with a decreased risk of in-hospital bleeding requiring transfusion and an increased risk of in-hospital MI compared to heparin. © 2017 Wiley Periodicals, Inc.
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
Matthew J
http://orcid.org/0000-0002-8039-4956
MJ
Czarny
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
Chao-Wei
CW
Hwang
Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, Maryland.
Daniel Q
DQ
Naiman
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
Cynthia C
CC
Lemmon
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
Rani K
RK
Hasan
Center for Cardiac and Vascular Research, Washington Adventist Hospital, Takoma Park, Maryland.
Thomas
T
Wang
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
Thomas
T
Aversano
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D000991:Antithrombins / Q000009:adverse effects / Q000627:therapeutic use*; D001803:Blood Transfusion; D003327:Coronary Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000628:therapy; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006629:Hirudins / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D010446:Peptide Fragments / Q000009:adverse effects / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D057216:Propensity Score; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin
anticoagulation; catheterization; intervention