Abstract 17632: Bivalirudin versus Heparin in Patients with Acute Myocardial Infarction: A Meta-analysis of Randomized Trials
Introduction: There is uncertainty about the impact of bivalirudin, as compared to unfractionated heparin, on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI)
Hypothesis: We aimed to assess whether bivalirudin is superior to heparin in patients with STEMI.
Methods: A meta-analysis of randomized trials comparing bivalirudin versus heparin in patients with STEMI undergoing primary percutaneous coronary intervention was performed. Summary odds ratios (OR) with 95% confidence intervals (CI) were calculated using random effects model.
Results: Three randomized trials enrolling 7612 patients were included. At 30 days, bivalirudin, as compared to heparin, was associated with a similar risk of all-cause mortality (3.03% vs. 3.38%, OR 0.90, 95% CI [0.63 to 1.29], p=0.57). Bivalirudin significantly increased the risk of definite (1.98% vs. 0.86%, OR 2.53, 95% CI [1.31 to 4.87], p=0.006); definite or probable (2.11% vs. 1.10%, OR 2.30, 95% CI [1.08 to 4.90], p=0.03); and acute stent thrombosis (1.39% vs. 0.31%, OR 4.41, 95% CI [2.34 to 8.29], p<0.001); leading to nonsignificantly higher reinfarction rates (1.92% vs. 1.28%, OR 1.70, 95% CI [0.88 to 3.27], p=0.11), and to a significantly increased risk of ischemia driven revascularization (2.50% vs. 1.52%, OR 1.80, 95% CI [1.02 to 3.18], p=0.04) at 30 days. No firm evidence for a reduction in major bleeding associated with bivalirudin use was found (3.93% vs. 6.39%, OR 0.63, 95% CI [0.39 to 1.04], p=0.07).
Conclusions: In patients with STEMI, bivalirudin use, as compared to heparin, is associated with similar all-cause mortality at 30 days. However bivalirudin increases the risk of stent thrombosis and ischemia driven revascularization, while no strong evidence that it significantly reduces major bleeding at 30 days is present.
Author Disclosures: G. Ferrante: None. P. Pagnotta: None. E. Corrada: None. P. Presbitero: None.
- © 2014 by American Heart Association, Inc.