Abstract | BACKGROUND: METHODS AND RESULTS:
STEMI admissions from January 1, 2004 through March 31, 2008 among patients receiving PPCI and bivalirudin or heparin+GPI in the Premier hospital database were identified. The probability of receiving bivalirudin was estimated using individual and hospital variables; using propensity scores, each bivalirudin patient was matched to 3 heparin+GPI treated patients. The primary outcome was in-hospital death. Rates of bleeding, transfusion, length of stay, and in-hospital cost were secondary outcomes. There were 59,917 STEMI PPCIs receiving bivalirudin (n=6735) or heparin+GPI (n=53,182). Seventy-nine percent of bivalirudin patients matched, resulting in 21,316 STEMI PPCIs for analysis. Compared with heparin+GPI patients, bivalirudin patients had fewer deaths (3.2% versus 4.0%; P=0.011) and less inpatient bleeding (clinically apparent bleeding [6.9% versus 10.5%, P<0.0001], clinically apparent bleeding with transfusion [1.6% versus 3.0%, P<0.0001], and transfusion [5.9% versus 7.6%, P<0.0001]). Patients receiving bivalirudin had shorter average length of stay (mean 4.3 versus 4.5 days; P<0.0001), with lower in-hospital cost (mean $18,640 versus $19,967 [median $14,462 versus $16,003], P<0.0001). CONCLUSIONS: This large "real-world" retrospective analysis demonstrates that bivalirudin therapy compared with heparin+GPI is associated with a lower rate of inpatient death, inpatient bleeding, and decreased overall in-hospital cost in STEMI patients undergoing PPCI.
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Authors | Duane S Pinto, Augustina Ogbonnaya, Steven A Sherman, Patricia Tung, Sharon-Lise T Normand |
Journal | Circulation. Cardiovascular quality and outcomes
(Circ Cardiovasc Qual Outcomes)
Vol. 5
Issue 1
Pg. 52-61
(Jan 2012)
ISSN: 1941-7705 [Electronic] United States |
PMID | 22235065
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Antithrombins
- Hirudins
- Peptide Fragments
- Platelet Glycoprotein GPIIb-IIIa Complex
- Recombinant Proteins
- Heparin
- bivalirudin
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Topics |
- Acute Coronary Syndrome
(complications, economics, mortality, therapy)
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Angioplasty
- Antithrombins
(administration & dosage, adverse effects)
- Coronary Vessels
(pathology, surgery)
- Cost-Benefit Analysis
- Electrocardiography
- Female
- Hemorrhage
(etiology)
- Heparin
(administration & dosage, adverse effects)
- Hirudins
(administration & dosage, adverse effects)
- Humans
- Male
- Middle Aged
- Myocardial Infarction
(economics, etiology, mortality, therapy)
- Peptide Fragments
(administration & dosage, adverse effects)
- Platelet Glycoprotein GPIIb-IIIa Complex
(antagonists & inhibitors)
- Recombinant Proteins
(administration & dosage, adverse effects)
- Retrospective Studies
- Survival Analysis
- Treatment Outcome
- Young Adult
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