Bivalirudin and Heparin Effects on Coronary Flow, Microcirculation and Recovery of Left Ventricular Systolic Function after Primary Coronary Angioplasty

Abstract

In ST elevation myocardial infarction (STEMI) treated by primary per-coetaneous coronary intervention (PPCI), bivalirudin caused less bleeding and was as effective as combined heparin and IIb IIIa antagonist. Aim : Compare the effects of bivalirudin and heparin on coronary flow, microcirculation and recovery of left ventricular systolic function in patients with STEMI undergoing PPCI. Methods: Forty five patients with anterior STEMI undergoing PPCI, 30 treated with heparin and 15 with bivalirudin were compared. All patients had complete trans-thoracic Doppler echocardiographic studies and sampling of blood velocities in the left anterior descending coronary artery (LAD) early after PPCI and 5 days later. Results : TIMI and myocardial blush grades were similar in both groups before after PPCI. Peak LAD diastolic velocities early after PPCI were higher in the bivalirudin group 42.2±14.4 compared to the heparin group 34.06±8.27 cm/sec, p<0.03. Peak velocities in the LAD did not change significantly on follow up in both groups. Early diastolic velocity integrals in the LAD in patients treated with bivalirudin, 12.3±4.2 were higher than in those treated with heparin, 8.91±3.21cm, p<0.02, and this difference between the groups was maintained on late evaluation. Left ventricular systolic function parameters were similar in both treatment groups early and late after PPCI, however only heparin was associated with increase in these parameters on discharge from the hospital. Conclusions : Bivalirudin treatment in patients with anterior STEMI treated by PPCI was associated with higher LAD velocities and integrals compared to heparin, however only heparin increased LV systolic function after PPCI.