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Cited by 1,867

The DOI matches its Crossref record; 2 of the 2 references it cites were found in a registry or an index.

Bivalirudin during Primary PCI in Acute Myocardial Infarction

Open access
Stone, Gregg W., Witzenbichler, Bernhard, Guagliumi, Giulio, Peruga, Jan Z., Brodie, Bruce R., Dudek, Dariusz, Kornowski, Ran, Hartmann, Franz, Gersh, Bernard J., Pocock, Stuart J., Dangas, George, Wong, S. Chiu, Kirtane, Ajay J., Parise, Helen, Mehran, Roxana·2008·New England Journal of Medicine
DOI 10.1056/nejmoa0708191
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Abstract

BACKGROUND: Treatment with the direct thrombin inhibitor bivalirudin, as compared with heparin plus glycoprotein IIb/IIIa inhibitors, results in similar suppression of ischemia while reducing hemorrhagic complications in patients with stable angina and non-ST-segment elevation acute coronary syndromes who are undergoing percutaneous coronary intervention (PCI). The safety and efficacy of bivalirudin in high-risk patients are unknown. METHODS: We randomly assigned 3602 patients with ST-segment elevation myocardial infarction who presented within 12 hours after the onset of symptoms and who were undergoing primary PCI to treatment with heparin plus a glycoprotein IIb/IIIa inhibitor or to treatment with bivalirudin alone. The two primary end points of the study were major bleeding and combined adverse clinical events, defined as the combination of major bleeding or major adverse cardiovascular events, including death, reinfarction, target-vessel revascularization for ischemia, and stroke (hereinafter referred to as net adverse clinical events) within 30 days. RESULTS: Anticoagulation with bivalirudin alone, as compared with heparin plus glycoprotein IIb/IIIa inhibitors, resulted in a reduced 30-day rate of net adverse clinical events (9.2% vs. 12.1%; relative risk, 0.76; 95% confidence interval [CI] 0.63 to 0.92; P=0.005), owing to a lower rate of major bleeding (4.9% vs. 8.3%; relative risk, 0.60; 95% CI, 0.46 to 0.77; P<0.001). There was an increased risk of acute stent thrombosis within 24 hours in the bivalirudin group, but no significant increase was present by 30 days. Treatment with bivalirudin alone, as compared with heparin plus glycoprotein IIb/IIIa inhibitors, resulted in significantly lower 30-day rates of death from cardiac causes (1.8% vs. 2.9%; relative risk, 0.62; 95% CI, 0.40 to 0.95; P=0.03) and death from all causes (2.1% vs. 3.1%; relative risk, 0.66; 95% CI, 0.44 to 1.00; P=0.047). CONCLUSIONS: In patients with ST-segment elevation myocardial infarction who are undergoing primary PCI, anticoagulation with bivalirudin alone, as compared with heparin plus glycoprotein IIb/IIIa inhibitors, results in significantly reduced 30-day rates of major bleeding and net adverse clinical events. (ClinicalTrials.gov number, NCT00433966 [ClinicalTrials.gov].).

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Crossref · 10.1056/nejmoa0708191

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Metadata

Authors
Stone, G. W., Witzenbichler, B., Guagliumi, G., Peruga, J. Z., Brodie, B. R., Dudek, D., Kornowski, R., Hartmann, F., Gersh, B. J., Pocock, S. J., Dangas, G., Wong, S. C., Kirtane, A. J., Parise, H., & Mehran, R.
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2008-05-22
Volume
358
Issue
21
Pages
2218-2230
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa0708191
OpenAlex
W2156927593
Cited by
1,867
References
2
FWCI
122.31
Type
journal article
Language
en
Open access
bronze

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Bibliographic data: Semantic Scholar, OpenAlex, Crossref.

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