Efficacy and Safety of Bivalirudin During Percutaneous Coronary Intervention in Chronic Total Occlusion: A Retrospective Study

被引:2
作者
Zhang, Yanghui [1 ]
Zhang, Yahao
Chang, Chao [1 ]
Yan, Shumei [1 ]
Chen, Zheng [2 ]
Zhang, Lishuai [1 ]
Chen, Kui [1 ]
Liu, Guizhi [1 ]
机构
[1] Zhengzhou Univ, Dept Cardiol, Affiliated Hosp 1, Zhengzhou, Henan, Peoples R China
[2] Zhengzhou Univ, Dept Cardiac Surg, Affiliated Hosp 1, Zhengzhou, Henan, Peoples R China
关键词
Bivalirudin; chronic total occlusion; percutaneous coronary intervention; unfractionated heparin; MYOCARDIAL-INFARCTION; HEPARIN; TRIALS; MODEL; RISK;
D O I
10.1016/j.clinthera.2021.03.004
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Purpose: Bivalirudin as a thrombin inhibitor is proven to have a low risk of bleeding during percutaneous coronary intervention (PCI). Some evidence indicates comparable effectiveness and safety between bivalirudin and unfractionated heparin (UFH). Although bivalirudin during PCI offers more clinical and safety benefits to patients with chronic total occlusion (CTO), mostly via radial access, this has not been confirmed. The objective of this study was to examine the efficacy and safety of bivalirudin during percutaneous coronary intervention (PCI) in patients with CTO. Methods: This trial used a retrospective cohort study design. Medical information from 736 patients with CTO who underwent PCI with bivalirudin or UFH at the First Affiliated Hospital of Zhengzhou University from July 2019 to September 2020 was extracted and analyzed. The primary end point was the 30-day incidence of net adverse clinical events (NACEs), and the secondary end point was the major adverse cardiovascular events (MACEs), which were related to safety and efficacy, respectively. Other end points incorporated each component of the primary outcome, target vessel revascularization, and stent thrombosis. Clinical and procedural characteristics at baseline were adjusted by using a logistic regression model. Findings: Overall, 71.5% of patients with CTO used the radial approach. Both groups exhibited nonsignificant differences in the majority of baseline characteristics. The bivalirudin group was associated with a significant reduction in NACEs (12.9% vs 21.5%; P = 0.002) and major bleeding (2.5% vs 8.0%; P = 0.001) versus the UFH group at the end of the 30-day follow-up. The incidence of MACEs, myocardial infarction, death, stroke, stent thrombosis, and target vessel revascularization did not differ significantly between the 2 groups. Moreover, the bivalirudin group also reported a lower incidence of NACEs in the prespecified subgroups. (C) 2021 Elsevier Inc.
引用
收藏
页码:844 / 851
页数:8
相关论文
共 26 条
[1]  
Brilakis ES, 2014, J INVASIVE CARDIOL, V26, P261
[2]   Clinical end points in coronary stent trials - A case for standardized definitions [J].
Cutlip, Donald E. ;
Windecker, Stephan ;
Mehran, Roxana ;
Boam, Ashley ;
Cohen, David J. ;
van Es, Gerrit-Anne ;
Steg, P. Gabriel ;
Morel, Marie-angele ;
Mauri, Laura ;
Vranckx, Pascal ;
McFadden, Eugene ;
Lansky, Alexandra ;
Hamon, Martial ;
Krucoff, Mitchell W. ;
Serruys, Patrick W. .
CIRCULATION, 2007, 115 (17) :2344-2351
[3]  
Degrauwe S, 2015, Rev Med Suisse, V11, P1172
[4]   A validated prediction model for all forms of acute coronary syndrome - Estimating the risk of 6-month postdischarge death in an international registry [J].
Eagle, KA ;
Lim, MJ ;
Dabbous, OH ;
Pieper, KS ;
Goldberg, RJ ;
Van de Werf, F ;
Goodman, SG ;
Granger, CB ;
Steg, PG ;
Gore, JM ;
Budaj, A ;
Avezum, A ;
Flather, MD ;
Fox, KAA .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2004, 291 (22) :2727-2733
[5]   Bivalirudin or Heparin in Patients Undergoing Invasive Management of Acute Coronary Syndromes [J].
Gargiulo, Giuseppe ;
Carrara, Greta ;
Frigoli, Enrico ;
Vranckx, Pascal ;
Leonardi, Sergio ;
Ciociano, Nestor ;
Campo, Gianluca ;
Varbella, Ferdinando ;
Calabro, Paolo ;
Garducci, Stefano ;
Iannone, Alessandro ;
Briguori, Carlo ;
Ando, Giuseppe ;
Crimi, Gabriele ;
Limbruno, Ugo ;
Garbo, Roberto ;
Sganzerla, Paolo ;
Russo, Filippo ;
Lupi, Alessandro ;
Cortese, Bernardo ;
Ausiello, Arturo ;
Ierna, Salvatore ;
Esposito, Giovanni ;
Zavalloni, Dennis ;
Santarelli, Andrea ;
Sardella, Gennaro ;
Tresoldi, Simone ;
de Cesare, Nicoletta ;
Sciahbasi, Alessandro ;
Zingarelli, Antonio ;
Tosi, Paolo ;
van't Hof, Arnoud ;
Omerovic, Elmir ;
Brugaletta, Salvatore ;
Windecker, Stephan ;
Valgimigli, Marco .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2018, 71 (11) :1231-1242
[6]   Bivalirudin vs Heparin With or Without Tirofiban During Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction The BRIGHT Randomized Clinical Trial [J].
Han, Yaling ;
Guo, Jincheng ;
Zheng, Yang ;
Zang, Hongyun ;
Su, Xi ;
Wang, Yu ;
Chen, Shaoliang ;
Jiang, Tiemin ;
Yang, Ping ;
Chen, Jiyan ;
Jiang, Dongju ;
Jing, Quanmin ;
Liang, Zhenyang ;
Liu, Haiwei ;
Zhao, Xin ;
Li, Jing ;
Li, Yi ;
Xu, Bo ;
Stone, Gregg W. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2015, 313 (13) :1336-1346
[7]  
Kereiakes DJ, 2009, REV CARDIOVASC MED, V10, P72, DOI 10.3909/ricm10S20006
[8]   Incidence, Predictors and Impact of Severe Periprocedural Bleeding According to VARC-2 Criteria on 1-Year Clinical Outcomes in Patients After Transcatheter Aortic Valve Implantation [J].
Kochman, Janusz ;
Rymuza, Bartosz ;
Huczek, Zenon ;
Koltowski, Lukasz ;
Scislo, Piotr ;
Wilimski, Radoslaw ;
Scibisz, Anna ;
Stanecka, Paulina ;
Filipiak, Krzysztof J. ;
Opolski, Grzegorz .
INTERNATIONAL HEART JOURNAL, 2016, 57 (01) :35-40
[9]   Bivalirudin or unfractionated heparin in patients with acute coronary syndromes managed invasively with and without ST elevation (MATRIX): randomised controlled trial [J].
Leonardi, Sergio ;
Frigoli, Enrico ;
Rothenbuhler, Martina ;
Navarese, Eliano ;
Calabro, Paolo ;
Bellotti, Paolo ;
Briguori, Carlo ;
Ferlini, Marco ;
Cortese, Bernardo ;
Lupi, Alessandro ;
Lerna, Salvatore ;
Zavallonito-Parenti, Dennis ;
Esposito, Giovanni ;
Tresoldi, Simone ;
Zingarelli, Antonio ;
Rigattieri, Stefano ;
Palmieri, Cataldo ;
Liso, Armando ;
Abate, Fabio ;
Zimarino, Marco ;
Comeglio, Marco ;
Gabrielli, Gabriele ;
Chieffo, Alaide ;
Brugaletta, Salvatore ;
Mauro, Ciro ;
Van Mieghem, Nicolas M. ;
Heg, Dik ;
Juni, Peter ;
Windecker, Stephan ;
Valgimigli, Marco .
BMJ-BRITISH MEDICAL JOURNAL, 2016, 354
[10]   Exploration of Bivalirudin Use during Percutaneous Coronary Intervention for High Bleeding Risk Patients with Chronic Total Occlusion [J].
Li, Chenguang ;
Shen, Yi ;
Xu, Rende ;
Dai, Yuxiang ;
Chang, Shufu ;
Lu, Hao ;
Ge, Lei ;
Ma, Jianying ;
Qian, Juying ;
Ge, Junbo .
INTERNATIONAL HEART JOURNAL, 2018, 59 (02) :293-299