Comparison Of Anticoagulant And Antiplatelet Therapy In Patients With St-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention (Pci)

Objective: The aim of this study was to investigate the safety and efficacy of bivalirudin plus ticagrelor compared with heparin plus clopidogrel in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: 630 patients with ST-segment elevation myocardial infarction undergoing PCI were divided into a bivalirudin plus ticagrelor group and a heparin plus clopidogrel group. Patients assigned to ticagrelor were given a loading dose of 180 mg orally before PCI, followed by a maintenance dose of 90 mg twice a day. Clopidogrel was initiated with a loading dose of 600 mg and carried on with a maintenance dose of at least 75 mg every day. Bivalirudin or heparin was given to patients during the PCI. Results: At the end of 12-month follow-up, net adverse clinical events were observed in 32 patients (10.4%) of 308 given bivalirudin plus ticagrelor and 58 patients (18.4%) of 315 given heparin plus clopidogrel [ relative risk (RR), 0.564; 95% confidence interval (CI), 0.377-0.843; P=0.004]. The composite ischemic endpoint of death, re-infarction, target vessel revascularization, or stroke did not significantly differ between the two groups (RR, 0.670; 95% CI, 0.384-1.169; P=0.155). The rate of 12-month bleeding in the bivalirudin plus ticagrelor group was lower than that in the heparin plus clopidogrel group (4.2% versus 9.2%, P=0.013; RR=0.458; 95% CI, 0.243-0.865). In addition, bivalirudin combined with ticagrelor did not raise the incidence of 12-month stent thrombosis in the present study (0.6% vs 1.3% respectively, P=0.686). Conclusions: Among patients with STEMI undergoing primary PCI, bivalirudin plus ticagrelor reduced net adverse clinical events compared with heparin plus clopidogrel. This observation was mainly attributed to a decrease in bleeding events in the bivalirudin plus ticagrelor group, without statistical differences in major adverse cardiac or cerebral events or stent thrombosis compared with the heparin plus clopidogrel group.