Abstract 13072: Bivalirudin versus Heparin Monotherapy in Percutaneous Coronary Intervention Patients: a Comparison of Acute Adverse Outcomes and Long Term Mortality
Introduction: Bivalirudin compared with heparin has been shown to reduce rates of bleeding and death in patients undergoing primary percutaneous coronary intervention (PCI). In light of recent literature showing the opposite, the aim of the current study is to compare the acute and long-term outcomes of a contemporary population of patients undergoing PCI.
Hypothesis: There is no statistically significant difference in acute and long-term outcomes between heparin monotherapy and bivalirudin in PCI patients.
Methods: Prospective data from 1/1/11 till 3/31/13 at 2 tertiary care centers in the New York area was obtained. Univariate, bivariate and propensity score adjusted analyses were performed. The primary endpoint was acute adverse outcome (composite of death, MI, CVA, bleeding, and transfusion). The secondary one was long term all-cause mortality.
Results: Among the 6,719 PCI patients (1,209 heparin including 258 with bailout glycoprotein IIb/IIIa inhibitor, median follow up 19 months) heparin monotherapy patients were younger, more often males, Asian, Hispanic, with lower insurance coverage, and sicker presentation compared to bivalirudin. Bivalirudin use was associated with lower inhospital mortality compared to heparin monotherapy subjects (OR 0.39, p=0.024). In propensity score-adjusted analyses no statistically significant differences were noted (Table and Figure).
Conclusions: In an all comer PCI population bivalirudin use was not associated with a statistically significant difference in neither acute adverse outcomes nor long term mortality. Given the difference in cost, the use of a heparin monotherapy approach should be strongly considered.
- Percutaneous coronary intervention (PCI)
- Glycoprotein iib/iiia platelet inhibitors
Author Disclosures: G. Ephrem: None. M.C. Kim: None. R. Jauhar: None. P.M. Meraj: None.
- © 2014 by American Heart Association, Inc.