Revisiting the Efficacy and Safety of Bivalirudin in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Insights From a Mixed Treatment Comparison Meta-Analysis of Randomized Trials.

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
M Haisum Maqsood, Jacqueline E Tamis-Holland, Frederick Feit, Sripal Bangalore
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引用次数: 0

Abstract

Background: Randomized trials of bivalirudin in patients with ST elevation myocardial infarction (STEMI) have yielded heterogeneous results.

Aims: Our aim was to evaluate the efficacy and safety of four antithrombin regimens-unfractionated heparin (UFH), bivalirudin (stopped soon after percutaneous coronary intervention [PCI]), extended bivalirudin (continued for a few hours after PCI), and combined UFH and a Gp2b3a inhibitors (GPI) in patients who present with STEMI.

Methods: A PubMed, EMBASE, and clinicaltrials.gov databases were searched for randomized clinical trials (RCTs) of the above antithrombin in patients with STEMI. The primary outcome was net adverse cardiovascular events (NACE). The primary ischemic endpoint was major adverse cardiovascular events (MACE), and the primary safety endpoint was major bleeding, and other endpoints included all-cause mortality and stent thrombosis. The primary analysis compared the effect of these antithrombin regimens in reference to UFH using a mixed treatment comparison meta-analysis.

Results: In the 14 RCTs evaluating 25,415 patients with STEMI, when compared to UFH monotherapy, extended bivalirudin lowered NACE (OR = 0.71 with 95% CI: 0.53-0.96; moderate level of confidence) driven by a significant decrease in major bleeding (OR = 0.42 with 95% CI: 0.26-0.68; high level of confidence) without any significant difference in MACE or all-cause mortality. When compared with UFH monotherapy, UFH+GPI reduced risk of MACE (OR = 0.76 with 95% CI: 0.60-0.97; high level of confidence) but at the expense of an increase in major bleeding (OR = 1.48 with 95% CI: 1.11-1.98; high level of confidence) with no difference in NACE or all-cause mortality. For major bleeding, extended bivalirudin infusion ranked #1, bivalirudin ranked #2, UFH monotherapy ranked #3, and combined UFH and GPI ranked #4. For NACE, extended bivalirudin infusion ranked #1, bivalirudin ranked #2, combined UFH and GPI ranked #3, and UFH monotherapy ranked #4. Cluster plots for MACE and major bleeding demonstrated that extended bivalirudin had the best balance for efficacy and safety.

Conclusions: In patients undergoing PCI for STEMI, extended bivalirudin offers the best balance for primary ischemic (MACE) and safety (major bleeding) outcomes.

重新审视比伐卢定对接受经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死患者的疗效和安全性:来自随机试验混合治疗比较元分析的启示》。
背景:对 ST 段抬高型心肌梗死(STEMI)患者使用比伐卢定的随机试验结果各不相同。目的:我们的目的是评估四种抗凝血酶方案--非分数肝素(UFH)、比伐卢定(经皮冠状动脉介入治疗[PCI]后很快停药)、延长比伐卢定(PCI后持续数小时)以及UFH和Gp2b3a抑制剂(GPI)联合治疗STEMI患者的疗效和安全性:在 PubMed、EMBASE 和 clinicaltrials.gov 数据库中搜索了 STEMI 患者使用上述抗凝血酶的随机临床试验 (RCT)。主要结果为净不良心血管事件(NACE)。主要缺血性终点是主要不良心血管事件(MACE),主要安全性终点是大出血,其他终点包括全因死亡率和支架血栓形成。主要分析采用混合治疗比较荟萃分析法比较了这些抗凝血酶方案与 UFH 的疗效:在对25,415名STEMI患者进行评估的14项研究中,与UFH单药治疗相比,延长双醋瑞定可降低NACE(OR=0.71,95% CI:0.53-0.96;中度置信水平),主要原因是大出血显著减少(OR=0.42,95% CI:0.26-0.68;高度置信水平),而MACE或全因死亡率无显著差异。与 UFH 单药相比,UFH+GPI 可降低 MACE 风险(OR = 0.76,95% CI:0.60-0.97;高度置信水平),但以大出血增加为代价(OR = 1.48,95% CI:1.11-1.98;高度置信水平),NACE 或全因死亡率无差异。在大出血方面,延长输注比伐卢定排名第一,比伐卢定排名第二,UFH 单药排名第三,UFH 和 GPI 联合治疗排名第四。在NACE方面,延长双醋鲁定输注排在第一位,双醋鲁定排在第二位,UFH和GPI联合疗法排在第三位,UFH单药疗法排在第四位。MACE和大出血的聚类图显示,长效比伐卢定在疗效和安全性方面达到了最佳平衡:结论:对于因 STEMI 而接受 PCI 治疗的患者,长效比伐卢定能最好地平衡主要缺血(MACE)和安全性(大出血)结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.40
自引率
8.70%
发文量
419
审稿时长
2 months
期刊介绍: Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.
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