Heparin versus bivalirudin for non-primary percutaneous coronary intervention: A post-Hoc analysis of the CPORT-E trial

Matthew Czarny, Chao-Wei Hwang, Daniel Q. Naiman, Cynthia C. Lemmon, Rani Hasan, Thomas Wang, Thomas R Aversano

Research output: Contribution to journalArticle

Abstract

Objectives: To compare bivalirudin to heparin during non-primary percutaneous coronary intervention (PCI). Background: The optimal anticoagulant to support PCI remains uncertain. Methods: We performed a propensity score-based analysis comparing clinical outcomes of patients receiving heparin to those receiving bivalirudin during non-primary PCI. Results: Of 18,867 patients in the Cardiovascular Patient Outcomes Research Team Non-Primary PCI (CPORT-E) trial, we selected 7,913 patients undergoing non-staged PCI of whom 57.3% received heparin and 42.7% received bivalirudin. In-hospital myocardial infarction occurred in 4.4% of patients receiving bivalirudin and 3.0% of patients receiving heparin (relative risk [RR] 1.5, 95% confidence interval [CI] 1.1-2.1, P=0.022); this difference persisted at 6 weeks (5.0% vs. 3.6%, RR 1.4, 95% CI 1.0-1.8, P=0.041). There was no difference in all-cause mortality either in-hospital (0.2% vs. 0.1% for heparin vs. bivalirudin, P=0.887) or at 6 weeks (0.5% vs. 0.7%, P=0.567). In-hospital bleeding requiring transfusion occurred in 0.9% of patients receiving bivalirudin and 1.9% of patients receiving heparin (RR 0.4, 95% CI 0.3-0.7, P <0.001), but there was no difference at 6 weeks (2.7% for heparin vs. 1.9% for bivalirudin, RR 0.7, 95% CI 0.5-1.0, P=0.062). Conclusions: In patients undergoing non-primary PCI at hospitals without on-site cardiac surgery, bivalirudin was associated with a decreased risk of in-hospital bleeding requiring transfusion and an increased risk of in-hospital MI compared to heparin.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - 2017

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Percutaneous Coronary Intervention
Heparin
Confidence Intervals
Hemorrhage
bivalirudin
Propensity Score
Hospital Mortality
Anticoagulants
Thoracic Surgery
Myocardial Infarction
Outcome Assessment (Health Care)

Keywords

  • Anticoagulation
  • Catheterization
  • Intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{990fb9e8a0734f2ba21a297ac1dda576,
title = "Heparin versus bivalirudin for non-primary percutaneous coronary intervention: A post-Hoc analysis of the CPORT-E trial",
abstract = "Objectives: To compare bivalirudin to heparin during non-primary percutaneous coronary intervention (PCI). Background: The optimal anticoagulant to support PCI remains uncertain. Methods: We performed a propensity score-based analysis comparing clinical outcomes of patients receiving heparin to those receiving bivalirudin during non-primary PCI. Results: Of 18,867 patients in the Cardiovascular Patient Outcomes Research Team Non-Primary PCI (CPORT-E) trial, we selected 7,913 patients undergoing non-staged PCI of whom 57.3{\%} received heparin and 42.7{\%} received bivalirudin. In-hospital myocardial infarction occurred in 4.4{\%} of patients receiving bivalirudin and 3.0{\%} of patients receiving heparin (relative risk [RR] 1.5, 95{\%} confidence interval [CI] 1.1-2.1, P=0.022); this difference persisted at 6 weeks (5.0{\%} vs. 3.6{\%}, RR 1.4, 95{\%} CI 1.0-1.8, P=0.041). There was no difference in all-cause mortality either in-hospital (0.2{\%} vs. 0.1{\%} for heparin vs. bivalirudin, P=0.887) or at 6 weeks (0.5{\%} vs. 0.7{\%}, P=0.567). In-hospital bleeding requiring transfusion occurred in 0.9{\%} of patients receiving bivalirudin and 1.9{\%} of patients receiving heparin (RR 0.4, 95{\%} CI 0.3-0.7, P <0.001), but there was no difference at 6 weeks (2.7{\%} for heparin vs. 1.9{\%} for bivalirudin, RR 0.7, 95{\%} CI 0.5-1.0, P=0.062). Conclusions: In patients undergoing non-primary PCI at hospitals without on-site cardiac surgery, bivalirudin was associated with a decreased risk of in-hospital bleeding requiring transfusion and an increased risk of in-hospital MI compared to heparin.",
keywords = "Anticoagulation, Catheterization, Intervention",
author = "Matthew Czarny and Chao-Wei Hwang and Naiman, {Daniel Q.} and Lemmon, {Cynthia C.} and Rani Hasan and Thomas Wang and Aversano, {Thomas R}",
year = "2017",
doi = "10.1002/ccd.26953",
language = "English (US)",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "Wiley-Liss Inc.",

}

TY - JOUR

T1 - Heparin versus bivalirudin for non-primary percutaneous coronary intervention

T2 - A post-Hoc analysis of the CPORT-E trial

AU - Czarny, Matthew

AU - Hwang, Chao-Wei

AU - Naiman, Daniel Q.

AU - Lemmon, Cynthia C.

AU - Hasan, Rani

AU - Wang, Thomas

AU - Aversano, Thomas R

PY - 2017

Y1 - 2017

N2 - Objectives: To compare bivalirudin to heparin during non-primary percutaneous coronary intervention (PCI). Background: The optimal anticoagulant to support PCI remains uncertain. Methods: We performed a propensity score-based analysis comparing clinical outcomes of patients receiving heparin to those receiving bivalirudin during non-primary PCI. Results: Of 18,867 patients in the Cardiovascular Patient Outcomes Research Team Non-Primary PCI (CPORT-E) trial, we selected 7,913 patients undergoing non-staged PCI of whom 57.3% received heparin and 42.7% received bivalirudin. In-hospital myocardial infarction occurred in 4.4% of patients receiving bivalirudin and 3.0% of patients receiving heparin (relative risk [RR] 1.5, 95% confidence interval [CI] 1.1-2.1, P=0.022); this difference persisted at 6 weeks (5.0% vs. 3.6%, RR 1.4, 95% CI 1.0-1.8, P=0.041). There was no difference in all-cause mortality either in-hospital (0.2% vs. 0.1% for heparin vs. bivalirudin, P=0.887) or at 6 weeks (0.5% vs. 0.7%, P=0.567). In-hospital bleeding requiring transfusion occurred in 0.9% of patients receiving bivalirudin and 1.9% of patients receiving heparin (RR 0.4, 95% CI 0.3-0.7, P <0.001), but there was no difference at 6 weeks (2.7% for heparin vs. 1.9% for bivalirudin, RR 0.7, 95% CI 0.5-1.0, P=0.062). Conclusions: In patients undergoing non-primary PCI at hospitals without on-site cardiac surgery, bivalirudin was associated with a decreased risk of in-hospital bleeding requiring transfusion and an increased risk of in-hospital MI compared to heparin.

AB - Objectives: To compare bivalirudin to heparin during non-primary percutaneous coronary intervention (PCI). Background: The optimal anticoagulant to support PCI remains uncertain. Methods: We performed a propensity score-based analysis comparing clinical outcomes of patients receiving heparin to those receiving bivalirudin during non-primary PCI. Results: Of 18,867 patients in the Cardiovascular Patient Outcomes Research Team Non-Primary PCI (CPORT-E) trial, we selected 7,913 patients undergoing non-staged PCI of whom 57.3% received heparin and 42.7% received bivalirudin. In-hospital myocardial infarction occurred in 4.4% of patients receiving bivalirudin and 3.0% of patients receiving heparin (relative risk [RR] 1.5, 95% confidence interval [CI] 1.1-2.1, P=0.022); this difference persisted at 6 weeks (5.0% vs. 3.6%, RR 1.4, 95% CI 1.0-1.8, P=0.041). There was no difference in all-cause mortality either in-hospital (0.2% vs. 0.1% for heparin vs. bivalirudin, P=0.887) or at 6 weeks (0.5% vs. 0.7%, P=0.567). In-hospital bleeding requiring transfusion occurred in 0.9% of patients receiving bivalirudin and 1.9% of patients receiving heparin (RR 0.4, 95% CI 0.3-0.7, P <0.001), but there was no difference at 6 weeks (2.7% for heparin vs. 1.9% for bivalirudin, RR 0.7, 95% CI 0.5-1.0, P=0.062). Conclusions: In patients undergoing non-primary PCI at hospitals without on-site cardiac surgery, bivalirudin was associated with a decreased risk of in-hospital bleeding requiring transfusion and an increased risk of in-hospital MI compared to heparin.

KW - Anticoagulation

KW - Catheterization

KW - Intervention

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U2 - 10.1002/ccd.26953

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