A Meta-analysis Of Bivalirudin Compared With Unfractionated Heparin In Patients With Acute Coronary Syndromes Undergoing Urgent Percutaneous Coronary Intervention Versus Elective Percutaneous Coronary Intervention

Objectives:The aim of this study was to assess different clinical benefits of bivalirudin and unfractionated heparin(UFH)in two different PCI groups.Background:The optimal anticoagulant for patients with acute coronary syndromes(ACS)undergoing percutaneous coronary intervention(PCI)remains controversial.And the efficacy and safety of bivalirudin compared with UFH in patients with ACS undergoing urgent PCI versus elective PCI has not been reported.Methods:Literature was searched in PubMed,EMBASE,Cochrane Library and Clinical Trials.We performed a Meta-analysis using Rev Man 5.3software.Subgroup analyses were conducted according to UFH plus routine glycoproteinⅡb/Ⅲa inhibitors(GPI)versus bailout GPI.Results:13 randomized controlled trials involving 23500 patients were included.In urgent PCI,bivalirudin significantly decreased the risk of 30d all-cause mortality(RR 0.80;95%CI 0.67 to 0.96;P=0.02;I~2=0%),cardiac mortality(RR 0.76;95%CI 0.59 to 0.98;P=0.04;I~2=0%)and 30d major bleeding(RR 0.61;95%0.44 to 0.83;P=0.002;I~2=70%),but increased the risk of MI(RR 1.32;95%CI 1.02 to 1.72;P=0.04;I~2=20%),acute ST(RR2.76;95%CI 1.66 to 4.58;P<0.0001;I~2=11%).In elective PCI,bivalirudin was associated with a lower risk of 30d major bleeding(RR 0.68;95%CI 0.51to 0.91;P=0.01;I~2=3%),and no significant difference was observed in other endpoints.In urgent PCI,the risk of major bleeding varied depending on UFH plus routine GPI versus bailout GPI,while no variation was observed in elective PCI.Conclusions:Bivalirudin may confer an great advantage over UFH in patients undergoing elective PCI because of the lower risk of major bleeding without the increased risk of acute ST.