Study Finds No Difference in Outcomes of Transradial PCI in STEMI Patients Treated With Bivalirudin Versus Heparin

June 12, 2017—Ion S. Jovin, MD, et al published a report from the National Cardiovascular Data Registry (NCDR) that evaluated bivalirudin versus heparin as anticoagulant agents in patients undergoing transradial primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). The study is available online ahead of print in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions.

The investigators concluded that there was no difference in the composite endpoint of death, myocardial infarction, or stroke in patients undergoing primary PCI via transradial access and anticoagulated with bivalirudin or heparin.

As summarized in JACC: Cardiovascular Interventions, outcomes were compared in STEMI patients included in the NCDR's CathPCI database from 2009 to 2015 who underwent primary PCI via radial access and who were anticoagulated with bivalirudin or heparin. The sample included 67,368 patients, of whom 29,660 received bivalirudin and 37,708 received heparin.

The investigators reported that the two groups of patients did not significantly differ in their mean age or percentage of men. The unadjusted comparison showed no significant difference in the rate of the composite endpoint of death, myocardial infarction, or stroke (4.6% vs 4.7%; P = .47) and a significantly higher rate of acute stent thrombosis (1.0% vs 0.6%; P < .001) with bivalirudin compared with heparin.

After adjusting for multiple variables, including a propensity score reflecting the probability of receiving bivalirudin, the odds ratio of the composite endpoint of death, myocardial infarction, or stroke for bivalirudin versus heparin was 0.95 (95% confidence interval, 0.87–1.05; P = .152), and the odds ratio for acute stent thrombosis was 2.11 (95% confidence interval, 1.73–2.57) for bivalirudin versus heparin. Major bleeding rates were not significantly different, noted the investigators in JACC: Cardiovascular Interventions.