Bivalirudin Versus Heparin In Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Meta-Analysis

Objective: To evaluate the impact of bivalirudin versus heparin on efficacy and safety outcomes of patients with acute coronary syndrome undergoing percutaneous coronary intervention(PCI). Methods: The databases of Pub Med, MEDLINE, Embase,Elsevier, Cochrane Library, CNKI and Wan Fang Database were retrieved with computer for searching the randomized controlled trials(RCTs) about the bivalirudin versus heparin in patients with ACS Undergoing PCI. All materials were retrieved and evaluated independently by 2 reviewers, and then given a Meta-analysis by using Rev Man 5.3software. The outcomes mainly are MACE(all-cause death, myocardial infarction,revascularisation), major bleeding, acute and subacute stent thrombosis. Results: There were finally 12 RCT included involving 26 822 cases. The results of Meta-analysis showed that all-cause death(RR=1.02, 95%CI: 0.85-1.22, P=0.85), myocardial infarction(RR=1.15, 95%CI: 0.95-1.40, P=0.16), stent thrombosis in 30d(RR=1.36, 95%CI:0.89-2.07, P=0.15), subacute stent thrombosis(24h-30d)(RR=0.88, 95%CI: 0.54-1.42,P=0.60), revascularisation(RR=1.15, 95%CI: 0.98-1.34, P=0.08) did not significantly differ with bivalirudin compared to heparin with or without Glycoprotein Ⅱb/Ⅲa Inhibitors. Major bleeding was significantly reduced by bivalirudin compared to heparin(RR=0.61, 95%CI: 0.46-0.81, P=0.0008), Bivalirudin increased the risk of acute stent thrombosis(RR=3.76, 95%CI: 2.12-6.66, P<0.001). Conclusion: In patients with ACS Undergoing PCI, bivalirudin and heparin preparation have the similar outcomes on all-cause death, myocardial infarction, stent thrombosis in 30 d, subacute stent thrombosis,but bivalirudin is superior to heparin preparation in reducing bleeding risk after PCI,however, bivalirudin increases the rate of acute stent thrombosis.