Bivalirudin Versus Heparin During Percutaneous Coronary Intervention (PCI) in NSTEMI: Individual Patient Data Meta-Analysis of Large Randomized Trials
Pooled result · 30-day all-cause mortalityResult — go to the resultAdjusted odds ratio 1.24 95% CI 0.86–1.79Authors' conclusion
In patients with non-ST-segment-elevation myocardial infarction undergoing PCI, procedural anticoagulation with bivalirudin and heparin did not result in significantly different rates of mortality or ischemic events, including stent thrombosis and reinfarction. Bivalirudin reduced serious bleeding compared with heparin arising both from the access site and nonaccess sites.
Study context
- Population
- Patients with NSTEMI undergoing PCI
- Participants
- 12,155 patients5 RCTs
- Comparison
- Bivalirudin vs heparin during PCI
- Bivalirudinn = 6,040
- Heparinn = 6,115reference
- Outcome
- All-cause mortality (effectiveness) and serious bleeding (safety)
- Follow-up
- 30 days
Methodological details5 trials randomising ≥1000 patients
- 5 trials randomising ≥1000 patients
Pooled result
30-day all-cause mortality
Adjusted odds ratio
1.24
95% CI 0.86–1.79
P = 0.25
By group
Bivalirudinvs Heparin
adjusted OR 1.24 (95% CI 0.86–1.79); P = 0.25
As reported in the abstract
Further pooled results
Cardiac mortality, reinfarction, stent thrombosis
- Not significantly different
Consistency by post-PCI bivalirudin infusion, routine GP IIb/IIIa inhibitor use, and 1-year follow-up
- Outcomes consistent
Safety
| Outcome | Bivalirudin | Heparin | Adjusted OR (95% CI) | P value | |
|---|---|---|---|---|---|
| Serious bleeding (access site and non-access site) · 30 daysPrimary safety end point | 3.3% | 5.5% | 0.59 (0.48–0.72) | P < 0.0001 | |
| 0.512Adjusted odds ratio (log scale) |
Original publication
Bivalirudin Versus Heparin During PCI in NSTEMI: Individual Patient Data Meta-Analysis of Large Randomized Trials. Circulation. Published 25 September 2023. doi:10.
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