Summary:
In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), anticoagulation with bivalirudin followed by a prolonged high-dose infusion significantly reduced the risk of all-cause death or major bleeding compared to heparin monotherapy in patients with lower BMI (< 25 kg/m2), though it was associated with no additional benefit in patients with BMI ≥ 25 kg/m2.
| PICO | Description |
|---|---|
| Population | 6,016 adults with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI, stratified by BMI (< 25 kg/m2 vs. ≥ 25 kg/m2), predominantly via radial access. |
| Intervention | Procedural anticoagulation with bivalirudin followed by a prolonged high-dose infusion for 2–4 hours post-PCI. |
| Comparison | Heparin monotherapy administered during primary PCI without post-procedural infusion. |
| Outcome | In patients with BMI < 25 kg/m2, bivalirudin significantly reduced all-cause death or BARC types 3–5 bleeding at 30 days (3.2% vs. 5.7%; adjusted HR 0.56, 95% CI 0.40–0.79), whereas no significant difference was observed in patients with BMI ≥ 25 kg/m2 (2.9% vs. 2.9%; adjusted HR 0.97, 95% CI 0.62–1.52). |
Source: Zhang, Dali, et al. “BMI differences on anticoagulation with bivalirudin vs. heparin during primary PCI: a BRIGHT-4 subanalysis.” Read article here.
