In-Hospital Outcome Comparing Bivalirudin to Heparin in Real-World Primary Percutaneous Coronary Intervention

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Trials

Background:

• Conflicting results exist on bivalirudin efficacy in primary percutaneous coronary intervention (PPCI).
• Real-world data is needed to compare heparin and bivalirudin in PPCI outcomes.

Purpose of the Study:

• To evaluate and compare in-hospital outcomes of heparin versus bivalirudin in a large, real-world PPCI cohort.
• To investigate potential effect modifications by glycoprotein IIb/IIIa inhibitors (GPIs) and access site on outcomes.

Main Methods:

• Analysis of 7,023 consecutive patients from the Austrian Acute PCI Registry (2010-2014).
• Patients received either heparin (n=6430) or bivalirudin (n=593) with or without GPIs.
• Comparison of in-hospital mortality, major adverse cardiovascular events, net adverse clinical events, and bleeding events.

Main Results:

• No significant differences in in-hospital mortality, MACE, NACE, or TIMI bleeding between heparin and bivalirudin groups.
• Potential effect modification observed: bivalirudin showed a trend towards better outcomes with femoral access and GPI use.
• No significant difference in outcomes for radial access between the two anticoagulants.

Conclusions:

• Heparin and bivalirudin demonstrate similar short-term mortality and clinical outcomes in the real-world setting of PPCI.
• Bivalirudin may be favored over heparin in PPCI when femoral access is used, particularly with concomitant GPI administration.
• Further research is warranted to confirm these findings and optimize anticoagulant strategies in PPCI.