Yet Another Randomized Study of Bivalirudin in MI Patients

The net clinical benefit favored bivalirudin over heparin with or without a glycoprotein IIb/IIIa inhibitor.

Several recent studies comparing bivalirudin with various heparin and/or glycoprotein IIb/IIIa inhibitor (GPI) strategies have yielded conflicting results (NEJM JW Cardiol Feb 2015 and J Am Coll Cardiol 2015; 65:27 and 39;NEJM JW Cardiol Nov 2014 and Lancet 2014 Jul 5; [e-pub]). In this Chinese, industry-supported, multicenter study, 2194 patients with ST-elevation myocardial infarction (STEMI) or non-STEMI undergoing emergency percutaneous coronary intervention were randomized to:

Bivalirudin alone (0.75 mg/kg bolus; 1.75 mg/kg/hour infusion for a median of 3 hours postprocedure),
Heparin alone (100 U/kg), or
Heparin (60 U/kg) plus tirofiban (10 µg/kg bolus; 0.15 µg/kg/minute infusion for 18–36 hours).

The primary combined endpoint at 30 days …

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

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)