A Meta-analysis of Clinical Trials Evaluating the Impact of Bivalirudin-based Anticoagulation for Primary Percutaneous Coronary on Long term Mortality.

ABSTRACT Bivalirudin and heparin are the principal anticoagulants used during primary percutaneous coronary intervention (PCI) for patients experiencing ST-elevation myocardial infarctions. Based on previous meta-analyses, bivalirudin improves 30-day mortality rates compared to heparin, especially when vascular access is predominantly femoral. However, no meta-analysis has yet reported whether this mortality benefit with bivalirudin persists beyond 30 days. Scientific databases and websites were searched to find RCTs, and risk ratios (RRs) were calculated using random effect models. Data from four trials were analyzed. Compared to heparin +/- glycoprotein IIb/IIIa inhibitors (GPIs), bivalirudin decreased all-cause mortality (RR, 0.81; 95% CI, 0.69-0.94; p = 0.008), cardiac mortality (RR, 0.72; 95% CI, 0.60-0.88; p = 0.001), and net adverse clinical events (RR, 0.83; 95% CI, 0.72-0.97; p = 0.016) at 1 year. In conclusion, a bivalirudin-based anticoagulation strategy during primary PCI significantly decreases the 1-year risks for all-cause mortality, cardiac mortality, and net adverse clinical events compared to heparin +/- GPI.