Comparison of prolonged bivalirudin infusion versus intraprocedural in preventing myocardial damage after percutaneous coronary intervention in patients with angina pectoris.

Full Abstract

Modern antithrombotic strategies for patients undergoing percutaneous coronary interventions (PCIs) must take into account the risk of ischemic and hemorrhagic complications. Bivalirudin decreases the risk of hemorrhagic complications after PCI; however, concerns have been raised about its efficacy in preventing ischemic complications. We evaluated the effectiveness of a prolonged intra- and postprocedural bivalirudin infusion versus a standard regimen in preventing PCI-related myocardial damage. One hundred seventy-eight consecutive patients with stable or unstable angina and complex coronary anatomy were enrolled in this single-center, randomized, single-blinded study. Patients were randomized to bolus plus bivalirudin infusion during PCI (n = 90) or bolus plus bivalirudin infusion during and after PCI (4 hours, n = 88). The primary end point was incidence of periprocedural myocardial damage (creatine kinase-MB increase >or=3 times upper limit of normal). Secondary end points were 30-day and 6-month major adverse cardiovascular events (death, new Q-wave myocardial infarction, target vessel revascularization) and in-hospital bleeding (major/minor). The 2 groups did not differ significantly in baseline and procedural characteristics. The primary end point of the study was significantly less frequent in the prolonged infusion group (6.8% vs 16.7%, p = 0.041). No significant differences for secondary end points were observed. In conclusion, in patients undergoing complex PCI, a prolonged bivalirudin infusion after PCI compared to an intraprocedural-only regimen significantly decreased the incidence of periprocedural myocardial damage.

Author information

Author/s: Cortese, Bernardo (B); Picchi, Andrea (A); Micheli, Andrea (A); Ebert, Alberto Genovesi (AG); Parri, Francesca (F); Severi, Silva (S); Limbruno, Ugo (U);

Affiliation: Interventional Cardiology Unit, Ospedale della Misericordia, Grosseto, Italy. bcortese(-atsign-)gmail.com

Journal and publication information

Publication Type: Comparative Study; Journal Article; Randomized Controlled Trial

Journal: The American journal of cardiology (Am J Cardiol), published in United States. (Language: eng)

Reference: 2009-Oct; vol 104 (issue 8) : pp 1063-8

Dates: Created 2009/10/05; Completed 2009/10/20;

PMID: 19801025, status: MEDLINE (last retrieval date: 10/20/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article
(including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aged
Angina Pectoris - diagnosis; therapy
Angioplasty, Transluminal, Percutaneous Coronary - methods
Anticoagulants - administration & dosage
Antithrombins
Delayed-Action Preparations
Dose-Response Relationship, Drug
Electrocardiography
Female
Follow-Up Studies
Hirudins - administration & dosage

Associated Chemicals: Anticoagulants (0) ; Antithrombins (0) ; Delayed-Action Preparations (0) ; Hirudins (0) ; Peptide Fragments (0) ; Recombinant Proteins (0) ; bivalirudin (128270-60-0)

These are the highest related articles currently in the database: