Assessment of residual thrombus burden in patients with ST-segment elevation myocardial infarction undergoing bivalirudin versus unfractionated heparin infusion: The MATRIX (minimizing adverse hemorrhagic events by transradial access site and angioX) OCT study.

Garcia-Garcia, Hector M; Adamo, Marianna; Soud, Mohamad; Yacob, Omar; Picchi, Andrea; Sardella, Gennaro; Frigoli, Enrico; Limbruno, Ugo; Rigattieri, Stefano; Diletti, Roberto; Boccuzzi, Giacomo; Zimarino, Marco; Contarini, Marco; Russo, Filippo; Calabrò, Paolo; Andò, Giuseppe; Varbella, Ferdinando; Garducci, Stefano; Palmieri, Cataldo; Briguori, Carlo; ... (2019). Assessment of residual thrombus burden in patients with ST-segment elevation myocardial infarction undergoing bivalirudin versus unfractionated heparin infusion: The MATRIX (minimizing adverse hemorrhagic events by transradial access site and angioX) OCT study. (In Press). Catheterization and cardiovascular interventions Wiley-Blackwell 10.1002/ccd.28661

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BACKGROUND Residual stent strut thrombosis after primary percutaneous coronary intervention (PCI), negatively affects myocardial perfusion, may increase stent thrombosis risk, and it is associated with neointima hyperplasia at follow-up. OBJECTIVES To study the effectiveness of any bivalirudin infusion versus unfractionated heparin (UFH) infusion in reducing residual stent strut thrombosis in patients with ST-elevation myocardial infarction (STEMI). METHODS Multi-vessel STEMI patients undergoing primary PCI and requiring staged intervention were selected among those randomly allocated to two different bivalirudin infusion regimens in the MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and angioX) Treatment-Duration study. Those receiving heparin only were enrolled into a registry arm. Optical coherence tomography (OCT) of the infarct-related artery was performed at the end of primary PCI and 3-5 days thereafter during a staged intervention. The primary endpoint was the change in minimum flow area (ΔMinFA) defined as (stent area + incomplete stent apposition [ISA] area) - (intraluminal defect + tissue prolapsed area) between the index and staged PCI. RESULTS 123 patients in bivalirudin arm and 28 patients in the UFH arm were included. Mean stent area, percentage of malapposed struts, and mean percent thrombotic area were comparable after index or staged PCI. The ΔMinFA in the bivalirudin group was 0.25 versus 0.05 mm2 in the UFH group, which resulted in a between-group significant difference of 0.36 [95% CI: (0.05, 0.71); p = .02]. This was mostly related to a decrease in tissue protrusion in the bivalirudin group (p = .03). There was a trend towards more patients in the bivalirudin group who achieved a 5% difference in the percentage of OCT frames with the area >5% (p = .057). CONCLUSIONS The administration of bivalirudin after primary PCI significantly reduces residual stent strut thrombosis when compared to UFH. This observation should be considered hypothesis-generating since the heparin-treated patients were not randomly allocated.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Frigoli, Enrico; Karagiannis Voules, Alexios and Valgimigli, Marco

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1522-1946

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

09 Jan 2020 14:27

Last Modified:

10 Mar 2020 16:16

Publisher DOI:

10.1002/ccd.28661

PubMed ID:

31883294

Uncontrolled Keywords:

ST-segment elevation myocardial infarction bivalirudin heparin optical coherence tomography

BORIS DOI:

10.7892/boris.137925

URI:

https://boris.unibe.ch/id/eprint/137925

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