We evaluated 41,537 patients admitted with myocardial infarction without ST elevation on the SCAAR register and who had not received IIBIIIB glycoprotein inhibitors and divided them into two groups: 31,351 patients who received heparin versus 10,186 who received bivalirudin. We adjusted baseline characteristics of the two groups using the Propensity score with the exception of the number of stents implanted that, after adjustment, continued to be significant. No significant differences between heparin and bivalirudin mortality were observed both in the overall analysis or in the subgroups.
Conclusion: This large observational study failed to demonstrate superiority of bivalirudin over heparin in the absence of glycoprotein IIBIIIA.
Commentary: Perhaps the high rate of radial access and the absence of the glycoprotein inhibitors might explain that bivalirudin has shown advantages, mainly in bleeding.
Oskar Angeras
2013-05-21
Original title: Heparin versus bivalirudin in patients with NSTE-ACS undergoing PCI. A report from the Swedish coronary angiografy and angioplasty registry (SCAAR).
