Impact of Bivalirudin-based Anticoagulation for Primary Percutaneous Coronary Intervention on 1-year Mortality: A Comprehensive Meta-analysis of Clinical Trials
Tuesday, May 21, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Rahman Shah, M.D.
,
University of Tennessee health Science Center Memphis TN, Memphis, TN
Arshi Naz
,
Sir Syed College of Medical Sciences for Girls, Karachi, Pakistan
Pooja Sona Jagadish, M.D.
,
University of Tennessee Health Science Center, Memphis, TN
Asra K Butt, M.D.
,
UTHSC, Memphis, TN
Samuel Latham, MD
,
University of Tennessee health Science Center Memphis TN, Memphis, TN
James Turner
,
University of Tennessee health Science Center Memphis TN, Memphis, TN
Kirstin Hesterberg
,
University of Tennessee health Science Center Memphis TN, Memphis, TN
Background:
In several previous meta-analyses, bivalirudin use during primary percutaneous coronary intervention (PCI) has been shown to improve 30-day mortality compared to heparin (with and without glycoprotein IIb
/IIIa inhibitors [GPIs]), particularly when the predominant method of vascular access was femoral. However, it is not clear if the early mortality benefit persists into the longer term. In recent months, 1-year results have been reported for the largest trial in this field (MATRIX). Therefore, we performed a comprehensive meta-analysis of RCTs to determine the effect of a bivalirudin-based anticoagulation strategy during primary PCI on 1-year mortality.
Methods:
Scientific databases were searched for RCTs. Among the 7 identified trials, 1 was terminated prematurely, and 2 have not yet reported 1-year results. Therefore, data from 4 trials were used to calculate pooled risk ratios (RRs) using a random effects model.
Results:
Data from 14,929 patients were analyzed. The predominant method of vascular access was femoral, and a significant number of patients received routine GPI with heparin. Compared to heparin +/- GPI, bivalirudin decreased all-cause mortality by 19% (RR, 0.81; 95% CI, 0.69–0.94;
p = 0.008) and cardiac mortality by 28% (RR, 0.72; 95% CI, 0.60–0.88;
p = 0.001) at 1 year. It also significantly decreased net adverse clinical events at 1 year (RR, 0.83; 95% CI, 0.72–0.97;
p = 0.016).
Conclusions:
During primary PCI, a bivalirudin-based anticoagulation strategy decreases cardiac death and all-cause death at 1 year compared to heparin +/- GPI, particularly with femoral artery access.
