Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website http://www.cardiologyres.org

Original Article

Volume 10, Number 5, October 2019, pages 278-284

Bivalirudin Versus Heparin During Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

Figure 1. Forest plots of meta-analysis comparing MACE between bivalirudin and heparin arms. MACEs include composite death, myocardial infarction, and stroke. MACEs: major adverse cardiac events.

Figure 2. Forest plots of meta-analysis comparing cardiovascular mortality between bivalirudin and heparin. Cardiovascular mortality includes death due to acute myocardial infarction, pericardial tamponade, arrhythmia, peri-procedural complications or stroke.

Figure 3. Forest plots of meta-analysis comparing stent thrombosis between bivalirudin and heparin. Acute stent thrombosis occurs within 24 h of PCI; subacute stent thrombosis occurs within 30 days of PCI. STEMI: ST-segment myocardial infarction; NSTEMI: non-ST segment myocardial infarction; PCI: percutaneous coronary intervention.

Figure 4. Forest plots of meta-analysis comparing major bleeding among bivalirudin and heparin. GPI: glycoprotein IIb/IIIa inhibitors.

**Table 1.** Trial Characteristics
Trial	Bivalirudin sample size	Heparin sample size	Infarction	Mean age	Radial	Pretreatment with P2Y12 inhibitors	GPI using bivalirudin	GPI using heparin
^aHarmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction. ^bEuropean Ambulance Acute Coronary Syndrome Angiography. ^cHow Effective are Antithrombotic Therapies in Primary Percutaneous Coronary Intervention. ^dBavarian Reperfusion Alternatives Evaluation. ^eBivalirudin in Acute Myocardial Infarction vs. Heparin and GPI Plus Heparin Trial. ^fBivalirudin versus Heparin Monotherapy in Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated according to Recommended Therapies Registry Trial. ^gMinimizing Adverse Hemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox, includes Antithrombin and Treatment Duration studies.
HORIZONS-AMI^a	1,800	1,802	STEMI	60	6%	Clopidogrel	8%	98%
EUROMAX^b	1,089	1,109	STEMI	62	46%	Clopidogrel 40%, prasugrel 33%, ticagrelor 27%	12%	69%
HEAT-PPCI^c	905	907	STEMI	63	81%	Clopidogrel 11%, prasugrel 27%, ticagrelor 62%	13%	15%
BRAVE-4^d	271	277	STEMI	61	1%	Prasugrel + bivalirudin, clopidogrel + UFH	3%	6%
BRIGHT^e	735	1,459	STEMI 88%, NSTEMI 12%	58	79%	Clopidogrel	4%	6%, 100%
VALIDATE-SWEDEHEART^f	3,004	3,002	STEMI 50%, NSTEMI 50%	68	90%	Ticagrelor 94%, prasugrel 2%, cangrelor <1%	2.5%	2.8%
MATRIX^g	3,610	3,603	STEMI 56%, NSTEMI 44%	65	90%	Clopidogrel 46%, ticagrelor 24%, prasugrel 13%	4.6%	25.9%

Table 1. Trial Characteristics

Trial

Bivalirudin sample size

Heparin sample size

Infarction

Mean age

Radial

Pretreatment with P2Y12 inhibitors

GPI using bivalirudin

GPI using heparin

^aHarmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction. ^bEuropean Ambulance Acute Coronary Syndrome Angiography. ^cHow Effective are Antithrombotic Therapies in Primary Percutaneous Coronary Intervention. ^dBavarian Reperfusion Alternatives Evaluation. ^eBivalirudin in Acute Myocardial Infarction vs. Heparin and GPI Plus Heparin Trial. ^fBivalirudin versus Heparin Monotherapy in Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated according to Recommended Therapies Registry Trial. ^gMinimizing Adverse Hemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox, includes Antithrombin and Treatment Duration studies.

HORIZONS-AMI^a

1,800

1,802

STEMI

Clopidogrel

98%

EUROMAX^b

1,089

1,109

STEMI

46%

Clopidogrel 40%, prasugrel 33%, ticagrelor 27%

12%

69%

HEAT-PPCI^c

905

907

STEMI

81%

Clopidogrel 11%, prasugrel 27%, ticagrelor 62%

13%

15%

BRAVE-4^d

271

277

STEMI

Prasugrel + bivalirudin, clopidogrel + UFH

BRIGHT^e

735

1,459

STEMI 88%, NSTEMI 12%

79%

Clopidogrel

6%, 100%

VALIDATE-SWEDEHEART^f

3,004

3,002

STEMI 50%, NSTEMI 50%

90%

Ticagrelor 94%, prasugrel 2%, cangrelor <1%

2.5%

2.8%

MATRIX^g

3,610

3,603

STEMI 56%, NSTEMI 44%

90%

Clopidogrel 46%, ticagrelor 24%, prasugrel 13%

4.6%

25.9%