Objective: To compare the efficacies of various post-percutaneous coronary intervenetion (PCI) bivalirudin doses on net adverse clinical events (NACEs) and mortality.
Background: In primary PCI, lower risk of bleeding with bivalirudin (vs. unfractionated heparin [UFH]) is counterbalanced by an increased risk of acute stent thrombosis (ST). Several randomized clinical trials (RCTs) and a recent meta-analysis suggest that acute ST risk may be eliminated without compromising the bleeding benefit, but only if the full dose, not a low dose, of bivalirudin is continued post-PCI. However, it is not known whether this improved risk leads to lower rates of NACEs and mortality.
Methods: Scientific databases and Web sites were searched for RCTs. Trials were included if study patients were undergoing primary PCI for acute ST-segment elevation myocardial infarction and were randomly assigned to bivalirudin or UFH treatment. The bivalirudin arm was divided based on post-PCI bivalirudin dosage: The Biv-Full group received 1.75 mg/kg/h, the Biv-Low group, 0.25 mg/kg/h, and the Biv-No group, none.
Results: Six RCTs involving 16,842 patients were found. In pairwise meta-analysis, bivalirudin improved 30-day all-cause mortality by 35% and cardiac mortality by 32%, but did not yield a NACE rate better than that achieved with UFH. Subgroup analysis showed the Biv-Full group had a 46% lower NACE rate and 47% lower all-cause mortality than UFH. These effects were not seen in the other two groups. Network meta-analysis yielded similar results. At treatment ranking, the Biv-Full group yielded the best treatment efficacy.
Conclusions: In primary PCI, full-dose bivalirudin infusion for 3-4 hr after PCI appeared to improve NACE rates compared to UFH. It also seemed to be the most effective strategy for improving cardiac mortality and all-cause mortality. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ccd.26859 | DOI Listing |
Heart Lung Circ
January 2025
Australian National University, Canberra, ACT, Australia; National Capital Private Hospital, Canberra, ACT, Australia.
Background & Aim: The definition and clinical relevance of percutaneous coronary intervention (PCI)-related myocardial infarction (MI) has been a topic of significant debate and controversy. It has particularly garnered widespread attention recently due to a contemporary trend of including it as a component of primary end points in major trials. The study aimed to assess the clinical relevance of PCI-related MI (PMI) according to the Fourth Universal Definition of MI using a high-sensitivity troponin (hs-Tn) assay in a real-world setting.
View Article and Find Full Text PDFCardiovasc Interv Ther
January 2025
Department of Internal Medicine, Division of Cardiology, Iwate Medical University, 2-1-1 Idaidori, Yahaba-Cho, Shiwa-Gun, Iwate, 028-3695, Japan.
In clinical practice, the impact of procedural or patient-related risk factors on 1-year clinical outcomes in patients receiving 1-month of dual antiplatelet therapy (DAPT) followed by P2Y12 inhibitor monotherapy after contemporary percutaneous coronary intervention (PCI) remains unclear. Using data from the multi-center REIWA registry which included patients treated with thin-strut biodegradable polymer drug-eluting stent (BP-DES) and 1-month DAPT followed by P2Y12 inhibitor monotherapy, we assessed the primary endpoint (a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, ischemic or hemorrhagic stroke, and major or minor bleeding) in patients with and without procedural (treatment of three vessels, three or more lesions, three or more stents, bifurcation with two stents, long stenting, and target of chronic total occlusion) and patient-related risk factor (renal insufficiency, anemia, peripheral vascular disease, prior or current history of heart failure and advanced age of ≥ 75 years). Among the 1,202 patients who underwent complete revascularization by PCI, 276 (23.
View Article and Find Full Text PDFBMC Cardiovasc Disord
January 2025
Department of Cardiology, the First Hospital of China Medical University, No.155 North Nanjing Street, Heping District, Shenyang, China.
Aim: The objective of this study was to investigate the level of soluble suppression of tumorigenicity-2 (sST2) in patients with acute ST-segment elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (PCI), and to provide a new biomarker for clinical management and prognosis assessment.
Method: This was a prospective study. 148 STEMI patients following primary PCI were enrolled and divided into 2 groups by the median value of sST2 and afterwards followed up for 30 days to access the occurrence of major adverse cardiac events (MACEs), which were defined as cardiovascular death, heart failure and recurrent MI.
Background: The effect of worsening renal function and baseline chronic kidney disease (CKD) on outcomes in patients with chronic coronary syndrome in the setting of optimal medical therapy remains unknown.
Methods And Results: The REAL-CAD (Randomized Evaluation of Aggressive or Moderate Lipid Lowering Therapy With Pitavastatin in Coronary Artery Disease) study is a prospective, multicenter, randomized trial of high-dose (pitavastatin 4 mg/day) or low-dose (pitavastatin 1 mg/day) statin therapy in 12 118 patients with chronic coronary syndrome. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, stroke, or unstable angina requiring hospitalization (major adverse cardiac and cerebral events [MACCE]).
JACC Adv
December 2024
Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada.
Background: Valvular heart disease (VHD) management has evolved rapidly in recent decades, but disparities in health care access persist among countries with varying socioeconomic backgrounds.
Objectives: The purpose of this study was to investigate global mortality trends from VHD and assess the difference between middle- and high-income countries.
Methods: We obtained mortality data from the World Health Organization Mortality Database for VHD and its subgroups (rheumatic valvular disease [RVD], infective endocarditis [IE], aortic stenosis [AS], and mitral regurgitation [MR]) from 2000 to 2019.
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