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Use of Bivalirudin for Chronic Total Occlusion Percutaneous Intervention: Insights From the PROGRESS-CTO Registry

Louis Verreault-Julien, Bahadir Simsek, Spyridon Kostantinis

  • 1Emory University Hospital, 1364 Clifton Road NE, Suite F-607, Atlanta, GA 30322 USA. wissam.jaber@emory.edu.

The Journal of Invasive Cardiology
|February 23, 2023
PubMed

Insights

Bivalirudin use in chronic total occlusion percutaneous coronary intervention (CTO-PCI) showed similar safety outcomes compared to unfractionated heparin. Further research is needed to confirm bivalirudin

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Limited data exist regarding bivalirudin use in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
  • Assessing the safety and efficacy of bivalirudin in CTO-PCI is crucial for clinical practice.

Purpose of the Study:

  • To compare the outcomes of CTO-PCI using bivalirudin versus unfractionated heparin.
  • To evaluate the primary endpoint of net adverse cardiac events (NACE) in patients undergoing CTO-PCI with either anticoagulant.

Main Methods:

  • A comparison of CTO-PCIs performed with bivalirudin versus unfractionated heparin was conducted within the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO).
  • The primary endpoint was NACE, defined as major adverse cardiac events (MACE) and vascular complications.
  • Patient characteristics, procedural details, and clinical outcomes were analyzed.

Main Results:

  • Bivalirudin was used in only 0.75% of CTO-PCI procedures (73 out of 9723).
  • Procedural success rates, in-hospital NACE, MACE incidence, and vascular access complications were not significantly different between the bivalirudin and unfractionated heparin groups.
  • Multivariable analysis indicated no increased risk of NACE associated with bivalirudin use (OR, 0.99; 95% CI, 0.13-7.27).

Conclusions:

  • Bivalirudin is infrequently utilized in retrograde CTO-PCI procedures.
  • The incidence of adverse events was comparable between bivalirudin and unfractionated heparin.
  • Larger studies are warranted to definitively assess the safety profile of bivalirudin in CTO-PCI.
Abstract

Keywords:
chronic total occlusionpercutaneous coronary intervention

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