Bivalirudin Therapy Is Associated With Improved Clinical and Economic Outcomes in ST-Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention: Results From an Observational Database

Abstract

Background— Randomized trials show improved outcomes among acute coronary syndrome patients treated with bivalirudin. The objective of this analysis was to compare clinical and economic outcomes in ST-elevation myocardial infarction (STEMI) patients encountered in routine clinical practice undergoing primary percutaneous coronary intervention (PPCI), treated with bivalirudin or heparin+GP IIb/IIIa receptor inhibitor (heparin+GPI). Methods and Results— STEMI admissions from January 1, 2004 through March 31, 2008 among patients receiving PPCI and bivalirudin or heparin+GPI in the Premier hospital database were identified. The probability of receiving bivalirudin was estimated using individual and hospital variables; using propensity scores, each bivalirudin patient was matched to 3 heparin+GPI treated patients. The primary outcome was in-hospital death. Rates of bleeding, transfusion, length of stay, and in-hospital cost were secondary outcomes. There were 59 917 STEMI PPCIs receiving bivalirudin (n=6735) or heparin+GPI (n=53 182). Seventy-nine percent of bivalirudin patients matched, resulting in 21 316 STEMI PPCIs for analysis. Compared with heparin+GPI patients, bivalirudin patients had fewer deaths (3.2% versus 4.0%; P =0.011) and less inpatient bleeding (clinically apparent bleeding [6.9% versus 10.5%, P <0.0001], clinically apparent bleeding with transfusion [1.6% versus 3.0%, P <0.0001], and transfusion [5.9% versus 7.6%, P <0.0001]). Patients receiving bivalirudin had shorter average length of stay (mean 4.3 versus 4.5 days; P <0.0001), with lower in-hospital cost (mean $18 640 versus $19 967 [median $14 462 versus $16 003], P <0.0001). Conclusions— This large “real-world” retrospective analysis demonstrates that bivalirudin therapy compared with heparin+GPI is associated with a lower rate of inpatient death, inpatient bleeding, and decreased overall in-hospital cost in STEMI patients undergoing PPCI.