TY  - BOOK
AU  - Garcia-Garcia, Hector M
AU  - Soud, Mohamad
AU  - Yacob, Omar
TI  - 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
SN  - 1522-1946
PY  - 2020///
KW  - *Anticoagulants/ad [Administration & Dosage]
KW  - *Antithrombins/ad [Administration & Dosage]
KW  - *Coronary Thrombosis/th [Therapy]
KW  - *Heparin/ad [Administration & Dosage]
KW  - *Hirudins/ad [Administration & Dosage]
KW  - *Peptide Fragments/ad [Administration & Dosage]
KW  - *Percutaneous Coronary Intervention
KW  - *ST Elevation Myocardial Infarction/th [Therapy]
KW  - *Tomography, Optical Coherence
KW  - Aged
KW  - Anticoagulants/ae [Adverse Effects]
KW  - Antithrombins/ae [Adverse Effects]
KW  - Coronary Thrombosis/dg [Diagnostic Imaging]
KW  - Female
KW  - Hemorrhage/ci [Chemically Induced]
KW  - Heparin/ae [Adverse Effects]
KW  - Hirudins/ae [Adverse Effects]
KW  - Humans
KW  - Infusions, Parenteral
KW  - Italy
KW  - Male
KW  - Middle Aged
KW  - Neointima
KW  - Peptide Fragments/ae [Adverse Effects]
KW  - Percutaneous Coronary Intervention/ae [Adverse Effects]
KW  - Percutaneous Coronary Intervention/is [Instrumentation]
KW  - Predictive Value of Tests
KW  - Prospective Studies
KW  - Recombinant Proteins/ad [Administration & Dosage]
KW  - Recombinant Proteins/ae [Adverse Effects]
KW  - ST Elevation Myocardial Infarction/dg [Diagnostic Imaging]
KW  - Stents
KW  - Time Factors
KW  - Treatment Outcome
KW  - MedStar Heart & Vascular Institute
KW  - MedStar Washington Hospital Center
KW  - Internal Medicine Residency
KW  - Journal Article
N2  - 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; 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. Copyright (c) 2019 Wiley Periodicals, Inc; 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 (DELTAMinFA) defined as (stent area + incomplete stent apposition [ISA] area) - (intraluminal defect + tissue prolapsed area) between the index and staged PCI; 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); 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 DELTAMinFA 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)
UR  - https://dx.doi.org/10.1002/ccd.28661
ER  -