Abstract
Introduction: A lot of large studies (HORIZONS-AMI, BRIGHT, EUROMAX, etc.) have shown that bivalirudin in acute myocardial infarction patients undergoing primary percutaneous coronary intervention (PCI) could reduce the bleeding while prevent thrombosis. However, data on patients undergoing elective PCI are lacking which warrants research attention. Methods: 1152 patients undergoing elective PCI anticoagulated with bivalirudin and 10251 patients anticoagulated with UFH were performed propensity score matching at 1:2 ratio. Finally, 957 and 1713 patients were enrolled in bivalirudin and UFH group respectively. The safe endpoints were according to the Bleeding Academic Research Consortium (BARC). The effective endpoint was major adverse cardiac and cerebrovascular events (MACCE). Results: During one-year follow-up, multivariate Cox analysis showed bivalirudin group had a reduction in the risk of BARC 2, 3 or 5 bleeding (HR: 0.580, 95% CI: 0.340-0.989, P=0.045), but not in the risk of BARC 3 or 5 bleeding (P=0.214) compared with UFH with or without glycoprotein IIb/IIIa inhibitors (GPI) group. To further study, we also analyzed 254 (14.8%) patients with GPI in UFH group and then found the risk of BARC 2, 3 or 5 bleeding in bivalirudin group reduced (P=0.001). As for MACCE, there was no significant difference between bivalirudin group and UFH with or without GPI group (P=0.159). Moreover, there was also no significant difference in the risk of death, revascularization, intrastent thrombosis or stroke, but a reduction in the risk of MI between bivalirudin group and UFH with or without GPI group (P=0.002). Conclusions: In patients undergoing elective PCI, bivalirudin significantly reduced the risk of BARC 2, 3 or 5 bleeding, but not that of BARC 3 or 5 bleeding compared UFH with or without GPI. No significant difference in MACCE between two groups, while bivalirudin significantly reduced the risk of MI.
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