Background: Bivalirudin (Angiomax^짰) has been approved as an antithrombotic agent in patients (pts) undergoing percutaneous coronary intervention (PCI) but there is limited data on its usage in saphenous vein graft (SVG) interventions. The aim of this study was to evaluate the safety and efficacy of bivalirudin compared with heparin in pts undergoing SVG intervention with distal protection device (DPD).
Methods: Retrospective analysis of medical records of 114 pts who underwent SVG interventions with DPD was conducted. Among them 54 pts received bivalirudin (0.75 mg/kg bolus and 1.75 mg/kg/hr infusion) and 60 pts received heparin (40U/kg bolus) as single antithrombotic agent during the intervention. Dual antiplatelet therapy was commenced in all pts and recommended to continue aspirin indefinitely and clopidogrel for at least 6 months. Periprocedural complications, in-hospital events and 30 days clinical outcomes were compared.
Results: Baseline clinical characteristics were similar except higher history of myocardial infarction (MI) in the bivalirudin group. There was a trend toward lower in-hospital repeat PTCA (0.0% vs. 5.0%, P=0.096), non-Q wave MI (16.7% vs. 31.7%, P=0.06) and overall vascular complications (0.0% vs. 5.0%, P=0.096) in the bivalirudin group. Major CK-MB elevations (>5X normal) were significantly lower in the bivalirudin group (5.6% vs. 18.3%, P=0.04). At 1 month follow up, the clinical outcomes including death, MI, repeat revascularization and subacute thrombosis were similar between the two groups.
Conclusion: The usage of bivalirudin during SVG intervention with DPD is safe and associated with lower periprocedural CK-MB elevation, trend toward lower in-hospital complications compared to heparin. Bivalirudin should be considered as an alternative to heparin in pts undergoing SVG intervention with DPD.