Effect of postprocedural full-dose infusion of bivalirudin on acute stent thrombosis in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: Outcomes in a large real-world population.

Aim The current study aimed to evaluate the effect of prolonged full-does bivalirudin infusion in real-world population with ST-elevation Myocardial Infarction(STEMI). Background Subgroup data as well as meta analysis from randomized clinical trials have showed potency of post-procedural full dose infusion (1.75mg/kg/h) of bivalirudin on attenuating acute stent thrombosis(ST) after primary percutaneous coronary intervention(PCI). Methods In this multicenter retrospective observational study, 2047 consecutive STEMI patients treated with bivalirduin during primary PCI were enrolled in 65 Chinese centers between July 2013 and May 2016. The primary outcome was acute ST defined as ARC definite/probable within 24 hours after the index procedure, and the secondary endpoints included total ST, major adverse cardiac or cerebral events (MACCE, defined as death, re-infarction, stroke and target vessel revascularization) and all bleeding at 30 days. Results Among 2047 STEMI patients, 1123 (54.9%) were treated with post-procedrual bivalirudin full dose infusion (median 120 min)while the other 924 (45.1%) received low does (0.25mg/kg/h) or null post-procedural infusion. A total of 3 acute ST (0.3%) occurred in STEMI patients with none or low does prolonged infusion of bivairudin, but none was observed in those treated with post-PCI full does infusion(0.3% vs 0.0%, P=0.092). Outcomes on MACCE (2.1% vs. 2.7%, p=0.402), total bleeding (2.1% vs. 1.4%, p=0.217) at 30 days showed no significant difference between the two groups and no subacute ST was observed. Conclusion Post-PCI full-does bivalirudin infusion is safe and has a trend to protect against acute ST in STEMI patients undergoing primary PCI in real world settings. This article is protected by copyright. All rights reserved.