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Comparison of Clinical Outcomes: Bivalirudin With Transfemoral Access Versus Heparin With Transradial Access in
Jaya Mallidi1, John Ulahannan1, Vinod K Chaubey1
1From the Division of Cardiology, Department of Internal Medicine, Baystate Medical Center, Springfield, MA.
Insights
Heparin with radial access showed a trend toward fewer major adverse cardiovascular events (MACE) in primary percutaneous coronary intervention (PCI) patients compared to bivalirudin with femoral access. Outcomes were similar when excluding cardiogenic shock patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Optimal anticoagulation and access site selection are crucial for primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients.
- Current guidelines do not definitively establish the best combination for primary PCI.
- Understanding these factors can improve patient outcomes and reduce complications.
Purpose of the Study:
- To compare the efficacy and safety of different anticoagulation and access site strategies in primary PCI for STEMI.
- To evaluate major adverse cardiovascular events (MACE) and bleeding complications between bivalirudin with femoral access versus heparin with radial access.
Main Methods:
- Retrospective cohort study of 1074 adult patients undergoing primary PCI for STEMI between 2012-2014.
- Patients were categorized into bivalirudin/femoral (bival/fem), heparin/radial (hep/rad), or off-protocol groups.
- Multiple logistic regression was used to compare MACE and bleeding between the on-protocol groups.
Main Results:
- The heparin/radial group had a trend towards reduced MACE (2.8% vs. 5.1%) compared to the bivalirudin/femoral group.
- Cardiogenic shock patients were more frequent in the bivalirudin/femoral group (6.5% vs. 3.0%).
- Excluding cardiogenic shock patients revealed no significant differences in mortality or bleeding rates between groups.
Conclusions:
- Primary PCI patients showed a trend towards reduced inpatient MACE with heparin and radial access compared to bivalirudin and femoral access.
- In non-cardiogenic shock patients, mortality and bleeding rates were comparable between the two strategies.
- Further research may clarify optimal anticoagulation and access site choices in primary PCI.
Introduction:
The best combination of access site and anticoagulant used during primary percutaneous coronary intervention (PCI) in patients presenting with ST segment elevation myocardial infarction is not known.
Methods:
We conducted a retrospective cohort study of all patients >18 years of age who underwent primary PCI in 2 large regional ST segment elevation myocardial infarction centers in Massachusetts between 2012 and 2014. The cohort was divided into 3 groups: bival/fem, hep/rad, or off-protocol, based on anticoagulation and access used. We used multiple logistic regression model to compare major cardiovascular events-major adverse cardiovascular events (MACE) and bleeding complications between the 2 on-protocol groups (bival/fem and hep/rad).
Results:
Of the 1074 patients in this study, there were 443 (41%), 501 (47%), and 130 (12%) patients in bival/fem, hep/rad, and off-protocol groups, respectively. There were significantly higher number of cardiogenic shock patients in the bival/fem compared to the hep/rad group (6.5% vs. 3.0%, P < 0.001). There was a trend toward reduced MACE in the hep/rad group compared to bival/fem (2.8 % vs. 5.1%, P = 0.068). When cardiogenic shock patients are excluded, there is no significant difference in mortality rates (bival/fem: 2.7% vs. hep/rad: 1.0%, P = 0.07) or bleeding complications between the groups (hep/rad: 4.5% vs. bival/fem: 2.1%, P = 0.06).
Conclusions:
In patients undergoing primary PCI, there was a trend toward reduced inpatient MACE with the use of heparin and radial access compared with bivalirudin with femoral access. In patients without cardiogenic shock, there is no significant difference in mortality or bleeding rates between the 2 groups.
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