Bivalirudin vs Heparin Anticoagulation in STEMI: Confirmation of the BRIGHT-4 Results
Pooled result · 30-day all-cause mortalityResult — go to the resultAdjusted odds ratio 0.78 95% CI 0.62–0.99Authors' conclusion
In STEMI patients undergoing primary PCI, bivalirudin with a 2- to 4-hour post-PCI high-dose infusion reduced cardiac mortality and major bleeding without an increase in ischemic events compared with heparin monotherapy with provisional GPI use, confirming the BRIGHT-4 results.
Study context
- Population
- STEMI patients undergoing primary percutaneous coronary intervention (PCI)
- Participants
- 15,254 patients6 RCTs
- Comparison
- Bivalirudin vs heparin during primary PCI
- Outcome
- All-cause mortality
- Follow-up
- 30 days
Pooled result
30-day all-cause mortality
Adjusted odds ratio
0.78
95% CI 0.62–0.99
By group
Bivalirudin vs Heparin
adjusted OR 0.78 (95% CI 0.62–0.99)
As reported in the abstract
Further pooled results
| Outcome | Bivalirudin | Adjusted OR (95% CI) | |
|---|---|---|---|
| Cardiac mortality, reinfarction, stent thrombosis (all regimens)Cardiac mortality | 0.69 (0.54–0.88) | ||
| Cardiac mortality, reinfarction, stent thrombosis (all regimens)Reinfarction | 1.30 (1.02–1.65) | ||
| Cardiac mortality, reinfarction, stent thrombosis (all regimens)Stent thrombosis | 1.43 (1.05–1.93) | ||
| 30-day all-cause mortality, BRIGHT-4 regimens (bivalirudin + high-dose post-PCI infusion vs heparin without planned GPI; 4 trials, 6,244 patients) | 1.8% | 0.74 (0.48–1.12) | |
| Cardiac mortality, reinfarction, stent thrombosis, BRIGHT-4 regimensCardiac mortality | 0.62 (0.39–0.97) | ||
| Cardiac mortality, reinfarction, stent thrombosis, BRIGHT-4 regimensReinfarction | 0.89 (0.58–1.38) | ||
| Cardiac mortality, reinfarction, stent thrombosis, BRIGHT-4 regimensStent thrombosis | 0.80 (0.41–1.57) | ||
| 0.20.5125Adjusted odds ratio (log scale) |
Safety
| Outcome | Adjusted OR (95% CI) | |
|---|---|---|
| Major bleeding (all regimens) | 0.53 (0.44–0.64) | |
| Major bleeding, BRIGHT-4 regimens | 0.49 (0.35–0.70) | |
| 0.20.5125Adjusted odds ratio (log scale) |
Original publication
Bivalirudin vs Heparin Anticoagulation in STEMI: Confirmation of the BRIGHT-4 Results. J Am Coll Cardiol. Published 15 October 2024. doi:10.
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