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Antithrombotic regimens for percutaneous coronary intervention of the left main coronary artery: The EXCEL trial. | LitMetric

AI Article Synopsis

  • The EXCEL trial compared the impact of bivalirudin versus heparin and the use of glycoprotein IIb/IIIa inhibitors (GPI) on outcomes for patients undergoing left main coronary artery (LMCA) percutaneous coronary intervention (PCI).
  • Results showed that bivalirudin had higher rates of periprocedural myocardial infarction (MI) and composite endpoints at 30 days compared to heparin, although five-year outcomes were similar for both treatments.
  • Glycoprotein IIb/IIIa inhibitors were rarely used and did not show any significant association with adverse clinical outcomes.

Article Abstract

Objectives: We compared the effect of bivalirudin or heparin and use or nonuse of glycoprotein IIb/IIIa inhibitors (GPI) on the outcome of left main coronary artery (LMCA) percutaneous coronary intervention (PCI) in the randomized EXCEL trial.

Background: The optimal antithrombotic regimen to support PCI of the LMCA remains controversial because of low representation of this subset in clinical trials.

Methods: The PCI cohort (n = 928) in EXCEL was divided according to bivalirudin versus heparin antithrombin treatment and compared for the primary composite endpoint of death, myocardial infarction (MI), or stroke at 30 days and 5 years.

Results: Bivalirudin was used in 319 patients (34.4%). The composite endpoint at 30 days occurred in 7.2% versus 3.8% bivalirudin and heparin patients, respectively, p = .02; at 5 years, the composite endpoint occurred in 26.3% versus 19.9% bivalirudin and heparin patients, respectively, p = .02. Major bleeding was more frequent in bivalirudin patients (4.1% versus 1.3%, p = .008). There were no differences in stent thrombosis between the groups. Bivalirudin use was an independent predictor of the 30-day composite endpoint (OR 2.88, 95% CI 1.28-6.48, p = .01) but not of the 5-year composite endpoint (OR 1.30, 95% CI 0.84-2.02, p = .23). GPI use was infrequent (n = 67, 7.2%) and was not associated with adverse outcomes.

Conclusion: Among patients undergoing LMCA PCI in the EXCEL trial, procedural use of bivalirudin was associated with greater rates of periprocedural MI and the 30-day composite endpoint without reducing bleeding complications. Five-year outcomes were similar. GPIs were used infrequently and were not associated with clinical outcomes.

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Source
http://dx.doi.org/10.1002/ccd.28858DOI Listing

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