Assessment of residual thrombus burden in patients with ST-segment elevation myocardial infarction undergoing bivalirudin versus unfractionated heparin infusion: The MATRIX (minimizing adverse hemorrhagic events by transradial access site and angioX) OCT study
Randomized controlled trial published in Catheter Cardiovasc Interv (2019)
Abstract
BACKGROUND: Residual stent strut thrombosis after primary percutaneous coronary intervention (PCI), negatively affects myocardial perfusion, may increase stent thrombosis risk, and it is associated with neointima hyperplasia at follow-up. OBJECTIVES: To study the effectiveness of any bivalirudin infusion versus unfractionated heparin (UFH) infusion in reducing residual stent strut thrombosis in patients with ST-elevation myocardial infarction (STEMI). METHODS: Multi-vessel STEMI patients undergoing primary PCI and requiring staged intervention were selected among those randomly allocated to two different bivalirudin infusion regimens in the MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and angioX) Treatment-Duration study. Those receiving heparin only were enrolled into a registry arm. Optical coherence tomography (OCT) of the infarct-related artery was performed at the end of primary PCI and 3-5 days thereafter during a staged intervention. The primary endpoint was the change in minimum flow area (ΔMinFA) defined as (stent area + incomplete stent apposition [ISA] area) - (intraluminal defect + tissue prolapsed area) between the index and staged PCI. RESULTS: 123 patients in bivalirudin arm and 28 patients in the UFH arm were included. Mean stent area, percentage of malapposed struts, and mean percent thrombotic area were comparable after index or staged PCI. The ΔMinFA in the bivalirudin group was 0.25 versus 0.05 mm2 in the UFH group, which resulted in a between-group significant difference of 0.36 [95% CI: (0.05, 0.71); p = .02]. This was mostly related to a decrease in tissue protrusion in the bivalirudin group (p = .03). There was a trend towards more patients in the bivalirudin group who achieved a 5% difference in the percentage of OCT frames with the area >5% (p = .057). CONCLUSIONS: The administration of bivalirudin after primary PCI significantly reduces residual stent strut thrombosis when compared to UFH. This observation should be considered hypothesis-generating since the heparin-treated patients were not randomly allocated.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Резюме
Residual stent strut thrombosis after primary percutaneous coronary intervention (PCI), negatively affects myocardial perfusion, may increase stent thrombosis risk, and it is associated with neointima hyperplasia at follow-up.
Почему это важно для гирудотерапии
Данное подисследование MATRIX OCT изучало, снижает ли инфузия бивалирудина резидуальный тромбоз стратов стента по сравнению с нефракционированным гепарином у пациентов с STEMI (123 — бивалирудин, 28 — реестр гепарина), которым выполнялось первичное ЧКВ, с использованием оптической когерентной томографии для оценки изменений минимальной площади потока. Бивалирудин представляет собой синтетический прямой ингибитор тромбина, структурно производный от гирудина — мощного антикоагулянта из слюны медицинской пиявки (Hirudo medicinalis), что делает данную работу непосредственно релевантной для ASH, демонстрируя, как препарат, вдохновленный секретомом пиявки, проявляет себя в современной интервенционной кардиологии. Исследование показало достоверно большее улучшение минимальной площади потока на фоне бивалирудина (межгрупповая разница 0,36 мм², p = 0,02), главным образом за счет уменьшения тканевой протрузии. Однако эти результаты следует рассматривать как генерирующие гипотезу, поскольку пациенты, получавшие гепарин, не были распределены методом случайной выборки, и исследование не относится к самой гирудотерапии, а скорее к фармацевтическому аналогу соединения, производного из пиявки.
Цитирование
Assessment of residual thrombus burden in patients with ST-segment elevation myocardial infarction undergoing bivalirudin versus unfractionated heparin infusion: The MATRIX (minimizing adverse hemorrhagic events by transradial access site and angioX) OCT study.
Garcia-Garcia HM et al. · Catheter Cardiovasc Interv, 2019
Связанный клинический контекст
Узнайте, как это исследование связано с клинической практикой
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