Pinto Duane S, Kohli Payal, Fan Weihong, Kirtane Ajay J, Kociol Robert D, Meduri Christopher, Deliargyris Efthymios N, Prats Jayne, Reynolds Matthew R, Stone Gregg W, Michael Gibson C
Cardiology Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
Cardiology Division, University of California, San Francisco.
Catheter Cardiovasc Interv. 2016 Feb 15;87(3):363-73. doi: 10.1002/ccd.26023. Epub 2015 May 22.
Outcomes with bivalirudin compare favorably with heparin ± GPIIb/IIIa receptor inhibition (heparin ± GPI) during percutaneous coronary intervention (PCI). Patients with congestive heart failure (CHF) have increased risk for complications. The objective was to investigate clinical and economic outcomes for bivalirudin ± GPI vs. heparin ± GPI among PCI patients with CHF.
Using the Premier Hospital Database, PCI patients with CHF were stratified by anticoagulant: bivalirudin, bivalirudin ± GPI, heparin and heparin ± GPI. The probability of receiving bivalirudin ± GPI was estimated using individual and hospital variables. Using propensity scores, each bivalirudin ± GPI patient was matched to a heparin ± GPI patient. The primary outcome was in-hospital death. Bleeding rates, transfusion, length of stay and in-hospital cost were ascertained.
Overall, 116,313 patients at 315 hospitals received bivalirudin (n = 45,559) bivalirudin + GPI (n = 8,115), heparin (n = 27,972) or heparin + GPI (n = 34,667). Patients had STEMI (21.2%), NSTEMI (29.1%), unstable angina (16.6%), stable angina (5.7%) or other ischemic heart disease (24.2%). Of these, 79.1% of bivalirudin patients matched, resulting in 84,948 analyzed patients. Compared with heparin ± GPI patients, bivalirudin ± GPI patients had fewer deaths (3.3% vs. 3.9%; p < 0.0001), less clinically apparent bleeding (10.2% vs. 11.4%; p < 0.0001), clinically apparent bleeding with transfusion (2.7% vs. 3.2%, p <0.0001), and transfusion (8.5% vs. 9.8%, p < 0.0001). Patients receiving bivalirudin had shorter length of stay (6.3 vs. 6.8 days; p < 0.0001) and lower in-hospital cost (mean $26,706 vs. $27,166 [median $19,414 vs. $19,798]; p < 0.0001). In conclusion, this is the largest retrospective analysis of PCI patients with CHF and demonstrates bivalirudin ± GPI compared with heparin ± GPI is associated with lower inpatient rates of death, bleeding, and cost.
在经皮冠状动脉介入治疗（PCI）期间，比伐芦定的治疗效果优于肝素±糖蛋白IIb/IIIa受体抑制剂（肝素±GPI）。充血性心力衰竭（CHF）患者并发症风险增加。目的是研究CHF的PCI患者中，比伐芦定±GPI与肝素±GPI的临床和经济结局。
利用Premier医院数据库，将CHF的PCI患者按抗凝剂分层：比伐芦定、比伐芦定±GPI、肝素和肝素±GPI。使用个体和医院变量估计接受比伐芦定±GPI的概率。利用倾向评分，将每位比伐芦定±GPI患者与一位肝素±GPI患者进行匹配。主要结局是院内死亡。确定出血率、输血情况、住院时间和住院费用。
总体而言，315家医院的116,313例患者接受了比伐芦定（n = 45,559）、比伐芦定+GPI（n = 8,115）、肝素（n = 27,972）或肝素+GPI（n = 34,667）治疗。患者患有ST段抬高型心肌梗死（STEMI，21.2%）、非ST段抬高型心肌梗死（NSTEMI，29.1%）、不稳定型心绞痛（16.6%）、稳定型心绞痛（5.7%）或其他缺血性心脏病（24.2%）。其中，79.1%的比伐芦定患者匹配成功，最终纳入分析的患者有84,948例。与肝素±GPI患者相比，比伐芦定±GPI患者死亡人数更少（3.3%对3.9%；p < 0.0001），临床明显出血更少（10.2%对11.4%；p < 0.0001），因输血导致的临床明显出血更少（2.7%对3.2%，p <0.0001），输血情况也更少（8.5%对9.8%，p < 0.0001）。接受比伐芦定治疗的患者住院时间更短（6.3天对6.8天；p < 0.0001），住院费用更低（平均26,706美元对27,166美元[中位数19,414美元对19,798美元]；p < 0.0001）。总之，这是对CHF的PCI患者进行的最大规模回顾性分析，结果表明与肝素±GPI相比，比伐芦定±GPI与更低的住院死亡率、出血率和费用相关。
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