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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
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Anticoagulation with bivalirudin during percutaneous coronary intervention for ST-segment elevation myocardial

Joseph F Stella1, Ronald E Stella, Robert A Iaffaldano

  • 1Heart Care Centers of Illinois, Interventional Cardiology Division, 2338 New Street, Blue Island, IL, 60406, USA. jstella@heartcc.com

The Journal of Invasive Cardiology
|September 9, 2004
PubMed

Insights

Bivalirudin, a direct thrombin inhibitor, was safely used for ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) without glycoprotein IIb/IIIa inhibitors. This approach demonstrated excellent blood flow and low complication rates, suggesting feasibility for further trials.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Percutaneous coronary intervention (PCI) is the primary treatment for ST-segment elevation myocardial infarction (STEMI).
  • Bivalirudin has shown efficacy and safety in reducing bleeding events in non-STEMI PCI procedures compared to heparin with glycoprotein IIb/IIIa inhibitors.
  • Limited data exists on bivalirudin use in STEMI patients undergoing primary PCI.

Purpose of the Study:

  • To assess the safety and feasibility of using bivalirudin, a direct thrombin inhibitor (DTI), as a sole anticoagulant during primary PCI for STEMI.
  • To evaluate outcomes without the routine addition of glycoprotein (GP) IIb/IIIa inhibitors in high-risk STEMI patients.

Main Methods:

  • A retrospective analysis of 91 consecutive high-risk STEMI patients undergoing primary PCI.
  • Bivalirudin was administered as a bolus (0.75 mg/kg) followed by an infusion (1.75 mg/kg/hr).
  • Outcomes were monitored over a 30-day follow-up period.

Main Results:

  • The study included high-risk patients (40% female, 30% diabetes, 21% prior MI, 18% cardiogenic shock).
  • PCI involved balloons, stents, or both, with 41% receiving intra-aortic balloon pumps and 24% using closure devices.
  • Excellent Thrombolysis In Myocardial Infarction (TIMI) flow was achieved without additional GP IIb/IIIa inhibitors.

Conclusions:

  • Bivalirudin anticoagulation in STEMI patients undergoing primary PCI is feasible and safe.
  • Low mortality and complication rates were observed, supporting the use of bivalirudin without GP IIb/IIIa inhibitors.
  • Further large-scale controlled trials are warranted to confirm bivalirudin's effectiveness in this population.
Abstract

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