Abstract 14373: Clinical Outcomes of Percutaneous Coronary Intervention in Patients Receiving Short Term or Prolonged Infusions of Eptifibatide or Bivalirudin: Results From the Intermountain Heart Registry
Background: A primary conflict in anticoagulation during percutaneous coronary intervention (PCI) is the simultaneous desire to prevent both thrombosis and bleeding. In modern PCI with standard dual oral antiplatelet therapy, the use of heparin + short (<6 hrs) infusions of glycoprotein IIb/IIIa inhibitors (sGPI) and bivalirudin with no GPI (bival) have been proposed as potentially superior alternatives to the traditional heparin + prolonged (18-24 hrs) GPI (pGPI) infusions, but these strategies have not been directly compared.
Methods: From April 1994 to December 2011, all consecutive patients enrolled in the Intermountain Heart Registry who underwent successful PCI and were anticoagulated with pGPI (using eptifibatide), sGPI or bival were studied. TIMI major bleed (including any transfusion) at 30 days and death, nonfatal MI, urgent target vessel revascularization (UTVR) and MACE (death, MI or UTVR) at 1 year were ascertained. Multivariable logistic regression was used to determine independent odds ratios (OR).
Results: A total of 7,412 (pGPI, n=4,249, acute coronary syndrome presentation (ACS) = 72%; sGPI, n=298, ACS=70%; bival, n=2,865, ACS=59%) PCI’s in 6,751 unique patients (age=65±12 yrs, males=73%, diabetes=28%, smokers=15%) were included. TIMI major bleed was 6.9%, 2.7%, and 4.3% for pGPI, sGPI and bival respectively. Adverse events were death (5.3%, 3.5%, 5.7%), MI (7.6%, 10.2%, 4.9%), UTVR (0.6%, 0.7%, 0.2%) and MACE (12.5%, 13.7%, 10.1%) for pGPI, sGPI and bival respectively. See table for multivariable results.
Conclusion: When compared with traditional prolonged GPI infusions, both short infusion GPI and bivalirudin significantly reduced the incidence of TIMI major bleeding in patients undergoing successful PCI with no adverse effect on MACE. In the modern setting of dual oral antiplatelet therapy, prolonged infusions with GPI appear to be unnecessary.
- © 2013 by American Heart Association, Inc.