Bivalirudin Alone During Primary Percutaneous Coronary Intervention?

Results from a randomized, open-label study are encouraging, but important questions linger.

Previous study findings have suggested that bivalirudin may improve outcomes by reducing bleeding in patients undergoing percutaneous coronary intervention (Journal Watch Cardiology Dec 26 2007). In the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial, a large, industry-supported, randomized, open-label study, bivalirudin alone was compared with heparin (60 IU/kg) plus a glycoprotein (GP) IIb/IIIa inhibitor in 3602 patients with ST-segment-elevation MI undergoing primary PCI <12 hours after symptom onset. All patients received a thienopyridine (clopidogrel loading dose, 300 mg or 600 mg; most received 600 mg).

The rate of major cardiovascular events at 30 days in the bivalirudin group…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI