1
|
Bai Z, Wang Z, Feng Q, Zhang Y, Zhang M, Hou A, Wu Y, Qin Z, Chai L. Bivalirudin vs heparin in cardiac-cerebral ischemic and bleeding events among Chinese STEMI patients during percutaneous coronary intervention: a retrospective cohort study. Braz J Med Biol Res 2023; 56:e13013. [PMID: 37970924 PMCID: PMC10644965 DOI: 10.1590/1414-431x2023e13013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/10/2023] [Indexed: 11/19/2023] Open
Abstract
Although bivalirudin has been recently made available for purchase in China, large-scale analyses on the safety profile of bivalirudin among Chinese patients is lacking. Thus, this study aimed to compare the safety profile of bivalirudin and heparin as anticoagulants in Chinese ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). A total of 1063 STEMI patients undergoing PCI and receiving bivalirudin (n=424, bivalirudin group) or heparin (n=639, heparin group) as anticoagulants were retrospectively enrolled. The net adverse clinical events (NACEs) within 30 days after PCI were recorded, including major adverse cardiac and cerebral events (MACCEs) and bleeding events (bleeding academic research consortium (BARC) grades 2-5 (BARC 2-5)). The incidences of NACEs (10.1 vs 15.6%) (P=0.010), BARC 2-5 bleeding events (5.2 vs 10.3%) (P=0.003), and BARC grades 3-5 (BARC 3-5) bleeding events (2.1 vs 5.5%) (P=0.007) were lower in the bivalirudin group compared to the heparin group, whereas general MACCEs incidence (8.9 vs 6.4%) (P=0.131) and each category of MACCEs (all P>0.05) did not differ between two groups. Furthermore, the multivariate logistic analyses showed that bivalirudin (vs heparin) was independently correlated with lower risk of NACEs (OR=0.508, P=0.002), BARC 2-5 bleeding events (OR=0.403, P=0.001), and BARC 3-5 bleeding events (OR=0.452, P=0.042); other independent risk factors for NACEs, MACCEs, or BARC bleeding events included history of diabetes mellitus, emergency operation, multiple lesional vessels, stent length >33.0 mm, and higher CRUSADE score (all P<0.05). Thus, bivalirudin presented a better safety profile than heparin among Chinese STEMI patients undergoing PCI.
Collapse
Affiliation(s)
- Zhichao Bai
- Department of Cardiology, HanDan Central Hospital, Handan, China
| | - Zhenzhen Wang
- Department of Cardiology, HanDan Central Hospital, Handan, China
| | - Qiang Feng
- Department of Cardiology, HanDan Central Hospital, Handan, China
| | - Yapei Zhang
- The Fourth Department of Oncology, HanDan Central Hospital, Handan, China
| | - Mengying Zhang
- Department of Cardiology, HanDan Central Hospital, Handan, China
| | - Aijun Hou
- Department of Cardiology, HanDan Central Hospital, Handan, China
| | - Yiping Wu
- Department of Neurology, HanDan Central Hospital, Handan, China
| | - Zhenpeng Qin
- Information Section, HanDan Central Hospital, Handan, China
| | - Lina Chai
- Department of Cardiology, HanDan Central Hospital, Handan, China
| |
Collapse
|
2
|
Zhang P, Pang S, Du L, Li J, Su X. Clinical characteristics and outcomes of patients with intracerebral hemorrhage after acute myocardial infarction. Int J Cardiol 2023; 390:131218. [PMID: 37499951 DOI: 10.1016/j.ijcard.2023.131218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
Data regarding patients with intracranial hemorrhage (ICH) following acute myocardial infarction (AMI) is scarce. This study aims to investigate the incidence, clinical characteristics, prevention, treatment, and prognosis of ICH in patients with AMI. Among 5257 patients with AMI, 14 cases (0.27%) experienced ICH following AMI, including 11 males and three females. In-hospital mortality occurred in eight patients (57.1%), all of whom experienced sudden loss of consciousness. Six patients (42.6%) were classified as high or very high risk according to CRUSADE score, and seven patients (50.0%) were classified as high risk according to Academic Research Consortium for High Bleeding Risk (ARC-HBR). The CRUSADE and ARC-HBR scores can complement each other in risk assessment. All in-hospital deaths occurred within four days of ICH onset; The volume of ICH in patients who died in the hospital was significantly higher than in those who survived and were discharged, with 30 ml possibly serving as a threshold. The incidence of ICH following myocardial infarction is low; however, the mortality rate is extremely high, presenting considerable challenges for clinical treatment. Prevention, early detection, and prompt symptomatic management are essential for improving patient outcomes.
Collapse
Affiliation(s)
- Ping Zhang
- Department of Hematology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
| | - Shuo Pang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lijuan Du
- Department of Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junlei Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Su
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| |
Collapse
|
3
|
Riehle L, Gothe RM, Ebbinghaus J, Maier B, Bruch L, Röhnisch JU, Schühlen H, Fried A, Stockburger M, Theres H, Dreger H, Leistner DM, Landmesser U, Fröhlich GM. Implementation of the ESC STEMI guidelines in female and elderly patients over a 20-year period in a large German registry. Clin Res Cardiol 2023; 112:1240-1251. [PMID: 36764933 PMCID: PMC10449958 DOI: 10.1007/s00392-023-02165-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/27/2023] [Indexed: 02/12/2023]
Abstract
AIMS We investigated the implementation of new guidelines in ST-segment elevation myocardial infarction (STEMI) patients in a large real-world patient population in the metropolitan area of Berlin (Germany) over a 20-year period. METHODS From January 2000 to December 2019, a total of 25 792 patients were admitted with STEMI to one of the 34 member hospitals of the Berlin-Brandenburg Myocardial Infarction Registry (B2HIR) and were stratified for sex and age < 75 and ≥ 75 years. RESULTS The median age of women was 72 years (IQR 61-81) compared to 61 years in men (IQR 51-71). PCI treatment as a standard of care was implemented in men earlier than in women across all age groups. It took two years from the 2017 class IA ESC STEMI guideline recommendation to prefer the radial access route rather than femoral until > 60% of patients were treated accordingly. In 2019, less than 60% of elderly women were treated via a radial access. While the majority of patients < 75 years already received ticagrelor or prasugrel as antiplatelet agent in the year of the class IA ESC STEMI guideline recommendation in 2012, men ≥ 75 years lagged two years and women ≥ 75 three years behind. Amongst the elderly, in-hospital mortality was 22.6% (737) for women and 17.3% (523) for men (p < 0.001). In patients < 75 years fatal outcome was less likely with 7.2% (305) in women and 5.8% (833) in men (p < 0.001). After adjustment for confounding variables, female sex was an independent predictor of in-hospital mortality in patients ≥ 75 years (OR 1.37, 95% CI 1.12-1.68, p = 0.002), but not in patients < 75 years (p = 0.076). CONCLUSION In-hospital mortality differs considerably by age and sex and remains highest in elderly patients and in particular in elderly females. In these patient groups, guideline recommended therapies were implemented with a significant delay.
Collapse
Affiliation(s)
- Leonhard Riehle
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | | | - Jan Ebbinghaus
- Department of Cardiology, Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Birga Maier
- Berlin-Brandenburger Herzinfarktregister, Berlin, Germany
| | - Leonhard Bruch
- Department of Cardiology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Jens-Uwe Röhnisch
- Department of Cardiology, Vivantes Klinikum Kaulsdorf, Berlin, Germany
| | - Helmut Schühlen
- Direktorat Klinische Forschung und Akademische Lehre, Vivantes Netzwerk für Gesundheit GmbH, Berlin, Germany
| | - Andreas Fried
- Berlin-Brandenburger Herzinfarktregister, Berlin, Germany
| | | | - Heinz Theres
- Department of Cardiology, Martin-Luther Krankenhaus, Berlin, Germany
| | - Henryk Dreger
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - David M Leistner
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Georg M Fröhlich
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| |
Collapse
|
4
|
Li J, Liu X, Ma S, Na K, Qi Z, Xu Y, Qiu M, Han Y, Li Y. Effectiveness and safety of bivalirudin in elderly patients with coronary artery disease undergoing percutaneous coronary intervention: A real-world study. Catheter Cardiovasc Interv 2022; 99 Suppl 1:1448-1455. [PMID: 35077603 DOI: 10.1002/ccd.30099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the effectiveness and safety of bivalirudin compared with heparin monotherapy in elderly patients undergoing percutaneous coronary intervention (PCI). BACKGROUND Bivalirudin is recommended for periprocedural use in patients undergoing PCI who are of high bleeding risk. However, its safe and efficacious use in elderly patients, a typical high bleeding risk cohort, in real world practice is yet to be reported. METHODS In this single center, real-world observational study, 4736 consecutive elderly patients who underwent PCI were enrolled. Of these, 1240 were treated with bivalirudin and 3496 with heparin according to the periprocedural anticoagulation strategies of PCI. The primary outcome was 12-month net adverse clinical events (NACE) defined as a composite of cardiac death, myocardial infarction, stroke, revascularization, or any bleeding. Propensity score matching (PSM) was used to balance baseline characteristics between groups. RESULTS After PSM, bivalirudin was found to be associated with lower rates of NACE (19.1% vs. 24.7%, p = 0.002), cardiac death (2.7% vs. 4.3%, p = 0.038), and any bleeding (10.0% vs. 12.9%, p = 0.023) compared to heparin monotherapy. No differences were found in the incidences of myocardial infarction, stroke, revascularization, stent thrombosis (0.1% vs. 0.1%, p = 1.000), and major bleedings (0.5% vs. 0.5%, p = 1.000) between the two patient groups. CONCLUSION In this real-world observational study, periprocedural use of bivalirudin in elderly patients who underwent PCI was associated with less cardiac death and any bleeding compared to heparin monotherapy, without increased risk of stent thrombosis.
Collapse
Affiliation(s)
- Jing Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China.,Department of Cardiology, The Graduate School of Harbin Medical University, Harbin, China
| | - Xiying Liu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China.,Shenyang Pharmaceutical University, Shenyang, China
| | - Sicong Ma
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Kun Na
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China.,Shenyang Pharmaceutical University, Shenyang, China
| | - Zizhao Qi
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China.,Department of Cardiology, The Graduate School of Harbin Medical University, Harbin, China
| | - Ying Xu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Miaohan Qiu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yi Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| |
Collapse
|
5
|
Peng X, Li Z, Li D, Li Z, Lu Z, Luo C, Ji Z. Bivalirudin Presents a Favorable Safety Profile Regarding Adverse Drug Reactions, Thrombocytopenia, and Bleeding in Chinese Patients With High Bleeding Risk Undergoing Percutaneous Coronary Intervention: A Prospective, Multi-Center, Intensive Monitoring Study. Front Cardiovasc Med 2022; 9:821322. [PMID: 37168321 PMCID: PMC10166107 DOI: 10.3389/fcvm.2022.821322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/29/2022] [Indexed: 05/13/2023] Open
Abstract
Background This study aimed to comprehensively explore the occurrence and risk factors for adverse events (AEs) and adverse drug reactions (ADRs) (especially for thrombocytopenia and bleeding) in Chinese patients with high bleeding risk (older adults, or complicated with diabetes mellitus or renal function impairment) undergoing percutaneous coronary intervention (PCI) with bivalirudin as an anticoagulant. Methods A total of 1,226 patients with high bleeding risk who received PCI with bivalirudin as an anticoagulant from 27 Chinese medical centers were enrolled in this prospective, multi-center, intensive monitoring study. AEs, ADRs, thrombocytopenia, and bleeding were collected from admission to 72 h post-bivalirudin administration; subsequently, patients were followed up on the 30th day with the safety data collected as well. Results Adverse events were observed in 198 (16.2) patients, among which severe AEs occurred in 16 (1.3%) patients. Meanwhile, bivalirudin-related ADRs were reported in 66 (5.4%) patients, among which 5 (0.4%) patients experienced bivalirudin-related severe ADRs. Besides, thrombocytopenia and bleeding occurred in 45 (3.7%) and 19 (1.5%) patients, respectively. The subsequent multivariate logistic analysis revealed that age >75 years [p = 0.017, odds ratio (OR) = 1.856] and spontaneous coronary artery dissection (SCAD) (p = 0.030, OR = 2.022) were independently related to higher ADR risk; SCAD (p = 0.017, OR = 2.426) was independently correlated with higher thrombocytopenia risk, while radial artery access (p = 0.015, OR = 0.352) was independently correlated with lower thrombocytopenia risk; and the administration of bivalirudin preoperatively or intraoperatively (p = 0.013, OR = 5.097) was independently associated with higher bleeding risk. Conclusion Bivalirudin presents a favorable safety profile regarding ADRs, thrombocytopenia, and bleeding in Chinese patients with high bleeding risk undergoing PCI.
Collapse
Affiliation(s)
- Xiaoping Peng
- Department of Cardiovascular, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhenyong Li
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, China
| | - Dunheng Li
- Department of Cardiology, Tai’an First People’s Hospital, Tai’an, China
| | - Zhongyin Li
- Department of Cardiovascular, Puyang Oilfield General Hospital, Puyang, China
| | - Zhaohua Lu
- Department of Cardiology, Wuzhou People’s Hospital, Wuzhou, China
| | - Caidong Luo
- Department of Cardiology, Mianyang Central Hospital, Mianyang, China
- *Correspondence: Caidong Luo,
| | - Zheng Ji
- First Department of Cardiology, Tangshan Worker’s Hospital, Tangshan, China
- Zheng Ji,
| |
Collapse
|
6
|
Perl L, Franzé A, D’Ascenzo F, Golomb N, Levi A, Vaknin-Assa H, Greenberg G, Assali A, De Ferrari GM, Kornowski R. Elderly Suffering from ST-Segment Elevation Myocardial Infarction-Results from a Database Analysis from Two Mediterranean Medical Centers. J Clin Med 2021; 10:jcm10112435. [PMID: 34070865 PMCID: PMC8199382 DOI: 10.3390/jcm10112435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/12/2021] [Accepted: 05/27/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Little is known regarding primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) in the elderly. Methods: Data on 319 octogenarians, 641 septuagenarians, and 2451 younger patients was collected from an ongoing prospective registry of patients treated with pPCI for STEMI at two Mediterranean-area medical centers in 2009–2017. Results: More octogenarian patients were female (40.8 vs. 31.9 septuagenarians and 26.5% under 70 y, p < 0.01), had hypertension (79.5 vs. 69.5 and 45.9%, p < 0.01), renal failure (32.5 vs. 20.1 and 5.2%, p < 0.01), and a lower left-ventricular ejection fraction (42.0 vs. 44.9 and 47.6%, p = 0.012). At 1 month and 3 years after intervention, mortality was higher in the octogenarian patients (12.2 vs. 7.9%, p = 0.01; and 36.7 vs. 23.1%, p < 0.01, respectively), with no significant differences in the rates of recurrent myocardial infarction, target vessel revascularization, coronary artery bypass surgery, and cardiovascular death. Following adjustment for confounders, 3-year mortality was significantly higher in the octogenarians (HR 3.89 vs. 3.19 for septuagenarians, p < 0.01), but rates of major adverse cardiac events or cardiovascular death were not. Conclusions: Despite suffering from higher all-cause mortality, octogenarian patients treated with pPCI for STEMI do not suffer an increased risk of ischemic cardiac events relative to younger patients.
Collapse
Affiliation(s)
- Leor Perl
- Department of Cardiology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (N.G.); (A.L.); (H.V.-A.); (G.G.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
- Correspondence: or ; Tel.: +972-3-9372251; Fax: +972-3-9372460
| | - Alfonso Franzé
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10126 Turin, Italy; (A.F.); (F.D.)
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10126 Turin, Italy; (A.F.); (F.D.)
| | - Noa Golomb
- Department of Cardiology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (N.G.); (A.L.); (H.V.-A.); (G.G.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (N.G.); (A.L.); (H.V.-A.); (G.G.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (N.G.); (A.L.); (H.V.-A.); (G.G.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Gabriel Greenberg
- Department of Cardiology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (N.G.); (A.L.); (H.V.-A.); (G.G.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Abid Assali
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
- Department of Cardiology, Meir Medical Center, Tchernichovsky St 59, Kfar-Saba 4428164, Israel
| | - Gaetano M. De Ferrari
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy;
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (N.G.); (A.L.); (H.V.-A.); (G.G.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| |
Collapse
|
7
|
Chen H, Yu X, Kong X, Li L, Wu J, Ma L. Efficacy and safety of bivalirudin application during primary percutaneous coronary intervention in older patients with acute ST-segment elevation myocardial infarction. J Int Med Res 2020; 48:300060520947942. [PMID: 32985292 PMCID: PMC7536496 DOI: 10.1177/0300060520947942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective ST-segment elevation myocardial infarction (STEMI) is the most serious type
of acute coronary syndrome. This study aimed to investigate the efficacy and
safety of bivalirudin application during primary percutaneous coronary
intervention (PPCI) in older patients with acute STEMI. Methods A total of 672 older patients with STEMI (>75 years) who underwent PPCI
were studied. The primary endpoints were 30-day net adverse clinical events
(NACEs) post-emergency percutaneous coronary intervention, including major
adverse cardiac and cerebrovascular events (MACCEs) and Bleeding Academic
Research Consortium grades 2 to 5 (BARC 2–5) bleeding events. Results The incidence of NACEs and BARC 2–5 bleeding events in the bivalirudin group
was significantly lower than that in the unfractionated heparin group.
Multivariate Cox regression analysis showed that bivalirudin significantly
reduced 30-day NACEs (odds ratio: 0.700, 95% confidence interval:
0.492–0.995) and BARC 2–5 bleeding events (odds ratio: 0.561, 95% confidence
interval: 0.343–0.918). At 1-year follow-up, these results were similar. Conclusions Bivalirudin can be safely and effectively used during PPCI in older patients
with STEMI. Bivalirudin reduces the risks of NACEs and bleeding within 30
days after PPCI, without increasing the risks of MACCEs and stent thrombosis
compared with heparin.
Collapse
Affiliation(s)
- Hongwu Chen
- Anhui Provincial Cardiovascular Institute, Hefei, Anhui Province, China
| | - Xiaofan Yu
- Anhui Provincial Cardiovascular Institute, Hefei, Anhui Province, China.,Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China
| | - Xiangyong Kong
- Anhui Provincial Cardiovascular Institute, Hefei, Anhui Province, China
| | - Longwei Li
- Anhui Provincial Cardiovascular Institute, Hefei, Anhui Province, China
| | - Jiawei Wu
- Anhui Provincial Cardiovascular Institute, Hefei, Anhui Province, China
| | - Likun Ma
- Anhui Provincial Cardiovascular Institute, Hefei, Anhui Province, China
| |
Collapse
|
8
|
Wester A, Attar R, Mohammad MA, Isma N, James S, Omerovic E, Erlinge D, Koul S. Bivalirudin Versus Heparin Monotherapy in Elderly Patients With Myocardial Infarction: A Prespecified Subgroup Analysis of the VALIDATE-SWEDEHEART Trial. Circ Cardiovasc Interv 2020; 13:e008671. [PMID: 32216471 DOI: 10.1161/circinterventions.119.008671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elderly patients with acute myocardial infarction undergoing percutaneous coronary intervention are at increased risk of both ischemic and bleeding complications. The optimal anticoagulation strategy in these patients is uncertain. Therefore, we compared bivalirudin to heparin monotherapy in a contemporary cohort of such patients. METHODS A prespecified subgroup analysis of elderly patients with myocardial infarction (≥75 years) from the VALIDATE-SWEDEHEART trial (Bivalirudin Versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies Registry Trial) was performed. In the trial, patients were randomized to either bivalirudin or heparin monotherapy during percutaneous coronary intervention, with mandatory potent P2Y12 inhibition, routine radial artery access, and only bail-out glycoprotein IIb/IIIa inhibition. Kaplan-Meier event rates were assessed for the primary end point, consisting of a composite of all-cause death, myocardial reinfarction, or major bleeding, within 180 days. RESULTS The elderly (n=1592) had more than twice the risk of all events compared with younger patients (n=4406). Baseline and periprocedural characteristics were equal between bivalirudin (n=799) and heparin (n=793) treated patients ≥75 years. No differences were found in the elderly between bivalirudin and heparin monotherapy regarding the primary end point (180-day all-cause death, myocardial reinfarction, or major bleeding), the individual components of the primary end point, definite stent thrombosis, or stroke. CONCLUSIONS In this prespecified subgroup analysis of the VALIDATE-SWEDEHEART trial, elderly patients with myocardial infarction had a highly increased risk of all events. However, no difference in outcomes could be observed with an anticoagulation strategy with either bivalirudin or heparin as monotherapy in this patient group.
Collapse
Affiliation(s)
- Axel Wester
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden (A.W., R.A., M.A.M., N.I., D.E., S.K.)
| | - Rubina Attar
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden (A.W., R.A., M.A.M., N.I., D.E., S.K.).,Department of Cardiology, Clinical Medicine, Aalborg University, Denmark (R.A.)
| | - Moman A Mohammad
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden (A.W., R.A., M.A.M., N.I., D.E., S.K.)
| | - Nazim Isma
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden (A.W., R.A., M.A.M., N.I., D.E., S.K.)
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (S.J.)
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.O.)
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden (A.W., R.A., M.A.M., N.I., D.E., S.K.)
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden (A.W., R.A., M.A.M., N.I., D.E., S.K.)
| |
Collapse
|
9
|
Esteban-Fernández A, Bastarrika G, Castanon E, Coma-Canella I, Barba-Cosials J, Jiménez-Martín M, Alpendurada F, Gavira JJ, Azcárate-Agüero PM. Valor pronóstico de la cardiorresonancia magnética de estrés en pacientes ancianos. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
10
|
Clinical Outcomes of Bivalirudin Versus Heparin in Elderly Patients Undergoing Percutaneous Coronary Intervention: a Systematic Review and Meta-analysis of Randomized Controlled Trials. Cardiovasc Drugs Ther 2020; 34:101-111. [PMID: 32100149 DOI: 10.1007/s10557-020-06937-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to explore the safety and efficacy of bivalirudin in elderly patients undergoing percutaneous coronary intervention (PCI). METHODS An electronic search was conducted for randomized controlled trials with outcomes of interest in the elderly (≥ 65 years of age). Pooled risk ratios (RR) and 95% confidence interval (CI) using random effects Der Simonian-Laird models were calculated. Primary outcomes were net adverse clinical events (NACE) and major bleeding events at 30 days. Secondary outcomes were major adverse cardiac events (MACE) at 30 days. MACE, all-cause mortality, and NACE at 6-12 months were also examined. RESULTS Eleven trials that randomized a total of 15,895 elderly patients undergoing PCI to bivalirudin versus heparin were included. At 30 days, bivalirudin was associated with a reduced risk of NACE (0.86 [0.75-0.99], p = 0.04), mainly driven by reduction in major bleeding events (0.66 [0.54-0.80], p < 0.0001), as compared with heparin. On subgroup analyses based on the use of GPI in the heparin arm, benefit of major bleeding associated with bivalirudin appeared to be equally evident when GPI was used as a bailout (0.66 [0.46-0.94], p = 0.02) versus routine (0.67 [0.51-0.88], p = 0.004) adjunctive therapy with heparin. Subgroup analyses stratified by clinical presentation showed that benefit of bivalirudin in reducing NACE was even more obvious in the elderly group presenting with ST segment elevation myocardial infarction (STEMI) (0.76 [0.65-0.89], p = 0.0007), as compared with the overall (acute coronary syndrome or stable ischemic heart disease) group. No difference in MACE (0.94 [0.82-1.09], p = 0.42) was demonstrated between the two groups. Bivalirudin was associated with a similar risk of NACE (0.74 [0.39-1.42], p = 0.36) at 6 months and MACE (0.90 [0.68-1.19], p = 0.45) at 6-12 months, while a non-statistically significant trend toward lower all-cause mortality (0.70 [0.47-1.06], p = 0.09) at 1 year. CONCLUSION In elderly patients undergoing PCI, bivalirudin was associated with a lower risk of major bleeding events and the magnitude of benefit was not related to the use of GPI and irrespective of clinical presentation. Bivalirudin may reduce the NACE, particularly in elderly patients presenting with STEMI or in the setting of routine GPI use in the heparin arm, while no difference in MACE was demonstrated between the two groups.
Collapse
|
11
|
Esteban-Fernández A, Bastarrika G, Castanon E, Coma-Canella I, Barba-Cosials J, Jiménez-Martín M, Alpendurada F, Gavira JJ, Azcárate-Agüero PM. Prognostic role of stress cardiac magnetic resonance in the elderly. ACTA ACUST UNITED AC 2019; 73:241-247. [PMID: 30930252 DOI: 10.1016/j.rec.2019.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 02/12/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Several trials have tested the diagnostic and prognostic value of stress cardiac magnetic resonance (CMR) in ischemic heart disease. However, scientific evidence is lacking in the older population, and the available techniques have limitations in this population. The aim of this study was to evaluate the usefulness of stress CMR in the elderly. METHODS We prospectively studied consecutive patients referred for stress CMR to rule out myocardial ischemia. The cutoff age for the elderly population was 70 years. Stress CMR study was performed according to standardized international protocols. Hypoperfusion severity was classified according to the number of affected segments: mild (1-2 segments), moderate (3-4 segments), or severe (> 4 segments). We analyzed the occurrence of major events during follow-up (death, acute coronary syndrome, or revascularization). Survival was studied with the Kaplan-Meier method and multivariate Cox regression models. RESULTS Of an initial cohort of 333 patients, 110 were older than 70 years. In 40.9% patients, stress CMR was positive for ischemia. The median follow-up was 26 [18-37] months. In elderly patients there were 35 events (15 deaths, 10 acute coronary syndromes, and 10 revascularizations). Patients with moderate or severe ischemia were at a higher risk of events, adjusted for age, sex, and cardiovascular risk (HR, 3.53 [95%CI, 1.41-8.79]; P=.01). CONCLUSIONS Moderate to severe perfusion defects in stress CMR strongly predict cardiovascular events in people older than 70 years, without relevant adverse effects.
Collapse
Affiliation(s)
| | - Gorka Bastarrika
- Departamento de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Eduardo Castanon
- Departamento de Oncología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Isabel Coma-Canella
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Joaquín Barba-Cosials
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Marta Jiménez-Martín
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Francisco Alpendurada
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
| | - Juan José Gavira
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | | |
Collapse
|
12
|
Wang Y, Zhao HW, Wang CF, Fan CY, Zhang XJ, Zhu Y, Luo DF, Yu GN, Hou AJ, Luan B. Efficacy and safety of bivalirudin during percutaneous coronary intervention in high‐bleeding‐risk elderly patients with chronic total occlusion: A prospective randomized controlled trial. Catheter Cardiovasc Interv 2019; 93:825-831. [PMID: 30724035 DOI: 10.1002/ccd.28087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 12/29/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Yong Wang
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| | - Hong-Wei Zhao
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| | - Cheng-Fu Wang
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| | - Chun-Yu Fan
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| | - Xiao-Jiao Zhang
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| | - Yu Zhu
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| | - De-Feng Luo
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| | - Guo-Ning Yu
- Department of Science and Education, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| | - Ai-Jie Hou
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| | - Bo Luan
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning, People's Republic of China
| |
Collapse
|