Meta-Analysis Supports Bivalirudin in PCI Patients With Diabetes

August 21, 2015—Findings from a meta-analysis of randomized trials evaluating short- and long-term outcomes in diabetes patients undergoing percutaneous coronary intervention (PCI) with bivalirudin compared with heparin and glycoprotein IIb/IIIA inhibitors (GPI) were published by Ramez Nairooz, MD, et al in Catheterization and Cardiovascular Interventions (2015;86:364–375).

The investigators searched the literature for randomized controlled trials that compared heparin and GPI therapy with bivalirudin in diabetes patients undergoing PCI. The incidence of major adverse cardiovascular events (MACE), death from any cause, myocardial infarction (MI), urgent revascularization, major and minor bleeding (at 30 days), as well as all-cause mortality at 1 year were included, and meta-analysis was performed.

As summarized in Catheterization and Cardiovascular Interventions, a total of 5,137 patients with diabetes were included in four randomized trials. At 30 days, bivalirudin—compared with heparin and GPI—caused less major bleeding and less minor bleeding, and similar rates of MACE, MI, and urgent revascularization. Death from any cause at 30 days was numerically lower with bivalirudin use, but not statistically significant. 

Mortality at 1 year was significantly lower in diabetes patients treated with bivalirudin, compared with heparin and GPI. The investigators reported that a secondary analysis suggests that the major bleeding benefit with bivalirudin may be driven by mandated use of GPI in the heparin arm.