Swedish registry questions superiority of bivalirudin over heparin in patients undergoing PCI for NSTE-ACS

Results from a large observational study reported at EuroPCR 2013 (the official annual meeting of the European Association for Percutaneous Cardiovascular Interventions; EAPCI) this week question whether bivalirudin - The Medicines Company’s (Nasdaq: MDCO) Angiomax - is superior to heparin in the absence of GPIIb/IIIa blockade, showing similar 30-day mortality in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS) undergoing percutaneous coronary intervention (PCI).

European and US NSTE-ACS guidelines currently recommend bivalirudin alone as an alternative to unfractionated heparin plus GP IIb/IIIa receptor inhibitors in patients undergoing an intended urgent or early invasive strategy.

Researchers compared 30-day mortality with heparin alone to that with bivalirudin alone in patients with NSTE-ACS undergoing PCI between 2005 and 2011 in the Swedish coronary angiography and angioplasty registry (SCAAR). The registry records all coronary angiographies and PCIs carried out in Sweden. Results were analysed for 31,351 patients treated with heparin alone and 10,186 given bivalirudin. Oskar Angeras, Consultant Cardiology at Sahlgrenska University Hospital, Gothenburg, Sweden, reported that the adjusted odds ratio for 30-day mortality favoured heparin (1.53 for complete case analysis).