Efficacy And Safety Of Bivalirudin In Elderly Patients With ST-segment Elevation Myocardial Infarction

Objective:To investigate the efficacy and safety of bivalirudin and unfractionated heparin(UFH)during perioperative primary percutaneous coronary intervention(PCI)in elderly patients(≥65 years)with acute ST-segment elevation myocardial infarction(STEMI).Methods:Elderly patients(≥65 years)with acute STEMI who underwent primary PCI in the First Hospital of Jilin University from January 1 to December 31,2021 were retrospectively included.Eligible patients were divided into bivalirudin group and unfractionated heparin group according to perioperative anticoagulant drugs.Baseline data,surgical characteristics and in-hospital complications of the two groups were analyzed.Primary outcome: Net adverse clinical events(NACE a composite of MACCE and BARC type 3 or 5 bleeding)during hospitalization.Secondary outcome:Major adverse cardiac or cerebral events(MACCE a composite of all-cause death,recurrent myocardial infarction,emergency target revascularization or stroke)during hospitalization.Other outcomes included stent thrombosis,acquired thrombocytopenia,BARC1 or 2 bleeding,and BARC total bleeding events.Univariate logistic analysis was used to analyze the risk factors of adverse events during hospitalization in STEIMI patients after PCI,and multivariate logistic analysis was used to adjust for confounding factors.The rate of all-cause deaths in hospital was analyzed in eight subgroups of bivalirudin and unfractionated heparin.In all tests,P < 0.05 was considered as statistically significant difference.Results:1.Logistic univariate regression analysis found age,BARC type 3 or 5 bleeding enents,BARC total bleeding events,Killip grade II to IV,femoral artery route,high CRUSADE score,low creatinine clearance and low left ventricular ejection fraction were significantly correlated with all-cause mortality during hospitalization.The difference was statistically significant(P < 0.05).2.Logistic univariate regression analysis found operation duration,low left ventricular ejection fraction,high CRUSADE score,Killip grade II to IV,and femoral artery route were significantly correlated with the incidence of BARC total bleeding events during hospitalization.The difference was statistically significant(P < 0.05).3.Logistic univariate regression analysis found perioperative use of bivalirudin significantly reduced the rate of all-cause mortality during hospitalization compared with unfractionated heparin(P=0.04).4.Logistic multivariate analysis found that perioperative use of bivalirudin significantly reduced the rate of all-cause mortality(3.7% vs 8.9%,P=0.039)and MACCE(3.7% vs 9.7%,P=0.021)during hospitalization compared with unfractionated heparin.Bivalirudin can also reduced the rate of NACE during hospitalization compared with unfractionated heparin,but the difference was not statistically significant(5.3% vs.10.2%,P=0.099).Subgroup analysis showed that bivalirudin significantly reduced the rate of in-hospital all-cause mortality compared with unfractionated heparin in patients with Killip grade I and creatinine clearance rate ≥60ml/min.The difference was statistically significant(P < 0.05).Conclusions:In elderly STEMI patients,perioperative use of bivalirudin significantly reduce the rates of MACCE and all-cause mortality compared with unfractionated heparin during hospitalization.