Temporal trends, safety, and efficacy of bivalirudin in elective percutaneous coronary intervention

Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Hitinder S. Gurm, Dean E. Smith, Stan J. Chetcuti, David Share, Sanjaya Khanal, Arthur Riba, Andrew J. Carter, Thomas Lalonde, Eva Kline-Rogers, Michael O'Donnell, William O'Neill, Robert Safian, Mauro Moscucci

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: To evaluate the safety and efficacy of bivalirudin based therapy among patients undergoing percutaneous coronary intervention (PCI) for stable coronary artery disease in a large multicenter registry. Background: The REPLACE II trial demonstrated the non-inferiority of a strategy of bivalirudin compared with heparin and glycoprotein (GP) IIbIIIa inhibition in patients undergoing PCI. There is a paucity of outcome data with bivalirudin use in the setting of real-world PCI practice. Methods: We evaluated the outcome of 11,719 patients who underwent elective PCI for stable coronary artery disease (CAD) from 2002 to 2004 in a large regional consortium, and who were treated with bivalirudin (n = 2051) or with heparin and GP IIbIIIa inhibitors (n = 9,668). The primary endpoints were transfusion and in-hospital major adverse cardiovascular events (MACE) defined as the composite of death, MI, stroke, and any coronary artery bypass grafting (CABG) or target lesion revascularization. Results: Compared with patients who received heparin plus GP IIbIIIa inhibitors, patients who received bivalirudin had a similar incidence of post-procedural MI, stroke, in-hospital death, MACE (2.88 vs. 2.48, P = 0.30), or transfusion (2.83% vs. 2.41%, P = 0.27). Patients at greater risk of bleeding were more likely to be treated with bivalirudin. After adjusting for the propensity to receive bivalirudin and for baseline co-morbidities, there was no difference in the odds of MACE or the need for transfusion between the two groups. Conclusion: Compared with heparin plus GP IIbIIIa inhibition, use of bivalirudin in patients undergoing PCI for stable CAD is associated with similar ischemic and bleeding complications. Given the ease of administration and lower cost, bivalirudin provides an attractive treatment option in this patient population.

Original languageEnglish
Pages (from-to)197-203
Number of pages7
JournalJournal of Interventional Cardiology
Volume20
Issue number3
DOIs
StatePublished - Jun 1 2007

Fingerprint

Blue Cross Blue Shield Insurance Plans
Percutaneous Coronary Intervention
Safety
Heparin
Glycoproteins
Coronary Artery Disease
Stroke
Hemorrhage
bivalirudin
Coronary Artery Bypass
Registries
Morbidity
Costs and Cost Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Temporal trends, safety, and efficacy of bivalirudin in elective percutaneous coronary intervention : Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. / Gurm, Hitinder S.; Smith, Dean E.; Chetcuti, Stan J.; Share, David; Khanal, Sanjaya; Riba, Arthur; Carter, Andrew J.; Lalonde, Thomas; Kline-Rogers, Eva; O'Donnell, Michael; O'Neill, William; Safian, Robert; Moscucci, Mauro.

In: Journal of Interventional Cardiology, Vol. 20, No. 3, 01.06.2007, p. 197-203.

Research output: Contribution to journalArticle

Gurm, HS, Smith, DE, Chetcuti, SJ, Share, D, Khanal, S, Riba, A, Carter, AJ, Lalonde, T, Kline-Rogers, E, O'Donnell, M, O'Neill, W, Safian, R & Moscucci, M 2007, 'Temporal trends, safety, and efficacy of bivalirudin in elective percutaneous coronary intervention: Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium', Journal of Interventional Cardiology, vol. 20, no. 3, pp. 197-203. https://doi.org/10.1111/j.1540-8183.2007.00262.x
Gurm, Hitinder S. ; Smith, Dean E. ; Chetcuti, Stan J. ; Share, David ; Khanal, Sanjaya ; Riba, Arthur ; Carter, Andrew J. ; Lalonde, Thomas ; Kline-Rogers, Eva ; O'Donnell, Michael ; O'Neill, William ; Safian, Robert ; Moscucci, Mauro. / Temporal trends, safety, and efficacy of bivalirudin in elective percutaneous coronary intervention : Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. In: Journal of Interventional Cardiology. 2007 ; Vol. 20, No. 3. pp. 197-203.
@article{767d9f0c01d7463cbb237bdeba39461a,
title = "Temporal trends, safety, and efficacy of bivalirudin in elective percutaneous coronary intervention: Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium",
abstract = "Objective: To evaluate the safety and efficacy of bivalirudin based therapy among patients undergoing percutaneous coronary intervention (PCI) for stable coronary artery disease in a large multicenter registry. Background: The REPLACE II trial demonstrated the non-inferiority of a strategy of bivalirudin compared with heparin and glycoprotein (GP) IIbIIIa inhibition in patients undergoing PCI. There is a paucity of outcome data with bivalirudin use in the setting of real-world PCI practice. Methods: We evaluated the outcome of 11,719 patients who underwent elective PCI for stable coronary artery disease (CAD) from 2002 to 2004 in a large regional consortium, and who were treated with bivalirudin (n = 2051) or with heparin and GP IIbIIIa inhibitors (n = 9,668). The primary endpoints were transfusion and in-hospital major adverse cardiovascular events (MACE) defined as the composite of death, MI, stroke, and any coronary artery bypass grafting (CABG) or target lesion revascularization. Results: Compared with patients who received heparin plus GP IIbIIIa inhibitors, patients who received bivalirudin had a similar incidence of post-procedural MI, stroke, in-hospital death, MACE (2.88 vs. 2.48, P = 0.30), or transfusion (2.83{\%} vs. 2.41{\%}, P = 0.27). Patients at greater risk of bleeding were more likely to be treated with bivalirudin. After adjusting for the propensity to receive bivalirudin and for baseline co-morbidities, there was no difference in the odds of MACE or the need for transfusion between the two groups. Conclusion: Compared with heparin plus GP IIbIIIa inhibition, use of bivalirudin in patients undergoing PCI for stable CAD is associated with similar ischemic and bleeding complications. Given the ease of administration and lower cost, bivalirudin provides an attractive treatment option in this patient population.",
author = "Gurm, {Hitinder S.} and Smith, {Dean E.} and Chetcuti, {Stan J.} and David Share and Sanjaya Khanal and Arthur Riba and Carter, {Andrew J.} and Thomas Lalonde and Eva Kline-Rogers and Michael O'Donnell and William O'Neill and Robert Safian and Mauro Moscucci",
year = "2007",
month = "6",
day = "1",
doi = "10.1111/j.1540-8183.2007.00262.x",
language = "English",
volume = "20",
pages = "197--203",
journal = "Journal of Interventional Cardiology",
issn = "0896-4327",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Temporal trends, safety, and efficacy of bivalirudin in elective percutaneous coronary intervention

T2 - Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

AU - Gurm, Hitinder S.

AU - Smith, Dean E.

AU - Chetcuti, Stan J.

AU - Share, David

AU - Khanal, Sanjaya

AU - Riba, Arthur

AU - Carter, Andrew J.

AU - Lalonde, Thomas

AU - Kline-Rogers, Eva

AU - O'Donnell, Michael

AU - O'Neill, William

AU - Safian, Robert

AU - Moscucci, Mauro

PY - 2007/6/1

Y1 - 2007/6/1

N2 - Objective: To evaluate the safety and efficacy of bivalirudin based therapy among patients undergoing percutaneous coronary intervention (PCI) for stable coronary artery disease in a large multicenter registry. Background: The REPLACE II trial demonstrated the non-inferiority of a strategy of bivalirudin compared with heparin and glycoprotein (GP) IIbIIIa inhibition in patients undergoing PCI. There is a paucity of outcome data with bivalirudin use in the setting of real-world PCI practice. Methods: We evaluated the outcome of 11,719 patients who underwent elective PCI for stable coronary artery disease (CAD) from 2002 to 2004 in a large regional consortium, and who were treated with bivalirudin (n = 2051) or with heparin and GP IIbIIIa inhibitors (n = 9,668). The primary endpoints were transfusion and in-hospital major adverse cardiovascular events (MACE) defined as the composite of death, MI, stroke, and any coronary artery bypass grafting (CABG) or target lesion revascularization. Results: Compared with patients who received heparin plus GP IIbIIIa inhibitors, patients who received bivalirudin had a similar incidence of post-procedural MI, stroke, in-hospital death, MACE (2.88 vs. 2.48, P = 0.30), or transfusion (2.83% vs. 2.41%, P = 0.27). Patients at greater risk of bleeding were more likely to be treated with bivalirudin. After adjusting for the propensity to receive bivalirudin and for baseline co-morbidities, there was no difference in the odds of MACE or the need for transfusion between the two groups. Conclusion: Compared with heparin plus GP IIbIIIa inhibition, use of bivalirudin in patients undergoing PCI for stable CAD is associated with similar ischemic and bleeding complications. Given the ease of administration and lower cost, bivalirudin provides an attractive treatment option in this patient population.

AB - Objective: To evaluate the safety and efficacy of bivalirudin based therapy among patients undergoing percutaneous coronary intervention (PCI) for stable coronary artery disease in a large multicenter registry. Background: The REPLACE II trial demonstrated the non-inferiority of a strategy of bivalirudin compared with heparin and glycoprotein (GP) IIbIIIa inhibition in patients undergoing PCI. There is a paucity of outcome data with bivalirudin use in the setting of real-world PCI practice. Methods: We evaluated the outcome of 11,719 patients who underwent elective PCI for stable coronary artery disease (CAD) from 2002 to 2004 in a large regional consortium, and who were treated with bivalirudin (n = 2051) or with heparin and GP IIbIIIa inhibitors (n = 9,668). The primary endpoints were transfusion and in-hospital major adverse cardiovascular events (MACE) defined as the composite of death, MI, stroke, and any coronary artery bypass grafting (CABG) or target lesion revascularization. Results: Compared with patients who received heparin plus GP IIbIIIa inhibitors, patients who received bivalirudin had a similar incidence of post-procedural MI, stroke, in-hospital death, MACE (2.88 vs. 2.48, P = 0.30), or transfusion (2.83% vs. 2.41%, P = 0.27). Patients at greater risk of bleeding were more likely to be treated with bivalirudin. After adjusting for the propensity to receive bivalirudin and for baseline co-morbidities, there was no difference in the odds of MACE or the need for transfusion between the two groups. Conclusion: Compared with heparin plus GP IIbIIIa inhibition, use of bivalirudin in patients undergoing PCI for stable CAD is associated with similar ischemic and bleeding complications. Given the ease of administration and lower cost, bivalirudin provides an attractive treatment option in this patient population.

UR - http://www.scopus.com/inward/record.url?scp=34249668866&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34249668866&partnerID=8YFLogxK

U2 - 10.1111/j.1540-8183.2007.00262.x

DO - 10.1111/j.1540-8183.2007.00262.x

M3 - Article

VL - 20

SP - 197

EP - 203

JO - Journal of Interventional Cardiology

JF - Journal of Interventional Cardiology

SN - 0896-4327

IS - 3

ER -