Impact of time to treatment on the effects of bivalirudin vs. glycoprotein IIb/IIIa inhibitors and heparin in patients undergoing primary percutaneous coronary intervention: insights from the HORIZONS-AMI trial
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Impact of time to treatment on the effects of bivalirudin vs. glycoprotein IIb/IIIa inhibitors and heparin in patients undergoing primary percutaneous coronary intervention: insights from the HORIZONS-AMI trial. / Schoos, Mikkel M; De Luca, Giuseppe; Dangas, George D; Clemmensen, Peter; Ayele, Girma Minalu; Mehran, Roxana; Stone, Gregg W.
In: EUROINTERVENTION, Vol. 12, No. 9, 20.10.2016, p. 1144-1153.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Impact of time to treatment on the effects of bivalirudin vs. glycoprotein IIb/IIIa inhibitors and heparin in patients undergoing primary percutaneous coronary intervention: insights from the HORIZONS-AMI trial
AU - Schoos, Mikkel M
AU - De Luca, Giuseppe
AU - Dangas, George D
AU - Clemmensen, Peter
AU - Ayele, Girma Minalu
AU - Mehran, Roxana
AU - Stone, Gregg W
PY - 2016/10/20
Y1 - 2016/10/20
N2 - AIMS: In the HORIZONS-AMI trial, bivalirudin compared to unfractionated heparin (UFH) plus a glycoprotein IIb/IIIa inhibitor (GPI) improved net clinical outcomes in patients undergoing primary percutaneous coronary intervention (PCI) at the cost of an increased rate of acute stent thrombosis. We sought to examine whether these effects are dependent on time to treatment.METHODS AND RESULTS: The interaction between anticoagulation regimen and symptom onset to first balloon inflation time (SBT) on the 30-day and three-year rates of major adverse cardiac events (MACE) was examined in 3,199 randomised patients according to SBT ≤3 hours versus >3 hours. Among patients with an SBT ≤3 hours, bivalirudin resulted in higher 30-day rates of MACE compared to UFH plus a GPI. Non-significant differences were observed in patients with an SBT >3 hours. Similar results were found for MACE at three years and stent thrombosis and reinfarction at 30 days and three years. By multivariable analysis, bivalirudin was an independent predictor of MACE at 30 days and three years in patients with an SBT ≤3 hours, but not in patients with SBT >3 hours.CONCLUSIONS: Bivalirudin compared to UFH plus a GPI is associated with an increased rate of stent thrombosis and MACE in patients with short SBTs, but not in those with longer SBTs.
AB - AIMS: In the HORIZONS-AMI trial, bivalirudin compared to unfractionated heparin (UFH) plus a glycoprotein IIb/IIIa inhibitor (GPI) improved net clinical outcomes in patients undergoing primary percutaneous coronary intervention (PCI) at the cost of an increased rate of acute stent thrombosis. We sought to examine whether these effects are dependent on time to treatment.METHODS AND RESULTS: The interaction between anticoagulation regimen and symptom onset to first balloon inflation time (SBT) on the 30-day and three-year rates of major adverse cardiac events (MACE) was examined in 3,199 randomised patients according to SBT ≤3 hours versus >3 hours. Among patients with an SBT ≤3 hours, bivalirudin resulted in higher 30-day rates of MACE compared to UFH plus a GPI. Non-significant differences were observed in patients with an SBT >3 hours. Similar results were found for MACE at three years and stent thrombosis and reinfarction at 30 days and three years. By multivariable analysis, bivalirudin was an independent predictor of MACE at 30 days and three years in patients with an SBT ≤3 hours, but not in patients with SBT >3 hours.CONCLUSIONS: Bivalirudin compared to UFH plus a GPI is associated with an increased rate of stent thrombosis and MACE in patients with short SBTs, but not in those with longer SBTs.
KW - Aged
KW - Anticoagulants/therapeutic use
KW - Antithrombins/therapeutic use
KW - Cause of Death
KW - Drug Therapy, Combination
KW - Female
KW - Graft Occlusion, Vascular/epidemiology
KW - Heparin/therapeutic use
KW - Hirudins
KW - Humans
KW - Male
KW - Middle Aged
KW - Mortality
KW - Myocardial Infarction/epidemiology
KW - Myocardial Revascularization/statistics & numerical data
KW - Peptide Fragments/therapeutic use
KW - Percutaneous Coronary Intervention/methods
KW - Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors
KW - Postoperative Complications/epidemiology
KW - Recombinant Proteins/therapeutic use
KW - Recurrence
KW - ST Elevation Myocardial Infarction/therapy
KW - Stroke/epidemiology
KW - Thrombosis/epidemiology
KW - Time-to-Treatment/statistics & numerical data
KW - Treatment Outcome
U2 - 10.4244/EIJV12I9A186
DO - 10.4244/EIJV12I9A186
M3 - SCORING: Journal article
C2 - 27753600
VL - 12
SP - 1144
EP - 1153
JO - EUROINTERVENTION
JF - EUROINTERVENTION
SN - 1774-024X
IS - 9
ER -
