Bivalirudin is associated with improved clinical and economic outcomes in heart failure patients undergoing percutaneous coronary intervention: Results from an observational database

Catheter Cardiovasc Interv. 2016 Feb 15;87(3):363-73. doi: 10.1002/ccd.26023. Epub 2015 May 22.

Abstract

Background: Outcomes with bivalirudin compare favorably with heparin ± GPIIb/IIIa receptor inhibition (heparin ± GPI) during percutaneous coronary intervention (PCI). Patients with congestive heart failure (CHF) have increased risk for complications. The objective was to investigate clinical and economic outcomes for bivalirudin ± GPI vs. heparin ± GPI among PCI patients with CHF.

Methods: Using the Premier Hospital Database, PCI patients with CHF were stratified by anticoagulant: bivalirudin, bivalirudin ± GPI, heparin and heparin ± GPI. The probability of receiving bivalirudin ± GPI was estimated using individual and hospital variables. Using propensity scores, each bivalirudin ± GPI patient was matched to a heparin ± GPI patient. The primary outcome was in-hospital death. Bleeding rates, transfusion, length of stay and in-hospital cost were ascertained.

Results: Overall, 116,313 patients at 315 hospitals received bivalirudin (n = 45,559) bivalirudin + GPI (n = 8,115), heparin (n = 27,972) or heparin + GPI (n = 34,667). Patients had STEMI (21.2%), NSTEMI (29.1%), unstable angina (16.6%), stable angina (5.7%) or other ischemic heart disease (24.2%). Of these, 79.1% of bivalirudin patients matched, resulting in 84,948 analyzed patients. Compared with heparin ± GPI patients, bivalirudin ± GPI patients had fewer deaths (3.3% vs. 3.9%; p < 0.0001), less clinically apparent bleeding (10.2% vs. 11.4%; p < 0.0001), clinically apparent bleeding with transfusion (2.7% vs. 3.2%, p <0.0001), and transfusion (8.5% vs. 9.8%, p < 0.0001). Patients receiving bivalirudin had shorter length of stay (6.3 vs. 6.8 days; p < 0.0001) and lower in-hospital cost (mean $26,706 vs. $27,166 [median $19,414 vs. $19,798]; p < 0.0001). In conclusion, this is the largest retrospective analysis of PCI patients with CHF and demonstrates bivalirudin ± GPI compared with heparin ± GPI is associated with lower inpatient rates of death, bleeding, and cost.

Keywords: bivalirudin; congestive heart failure; cost analysis; percutaneous coronary intervention.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anticoagulants / economics
  • Anticoagulants / therapeutic use
  • Antithrombins / adverse effects
  • Antithrombins / economics*
  • Antithrombins / therapeutic use*
  • Blood Loss, Surgical / prevention & control
  • Blood Transfusion / economics
  • Cost-Benefit Analysis
  • Databases, Factual
  • Drug Costs*
  • Female
  • Heart Failure / complications*
  • Heart Failure / diagnosis
  • Heart Failure / economics*
  • Heart Failure / mortality
  • Heparin / economics
  • Heparin / therapeutic use
  • Hirudins / adverse effects
  • Hirudins / economics*
  • Hospital Costs*
  • Hospital Mortality
  • Humans
  • Length of Stay / economics
  • Male
  • Middle Aged
  • Peptide Fragments / adverse effects
  • Peptide Fragments / economics*
  • Peptide Fragments / therapeutic use*
  • Percutaneous Coronary Intervention / adverse effects
  • Percutaneous Coronary Intervention / economics*
  • Percutaneous Coronary Intervention / mortality
  • Platelet Aggregation Inhibitors / economics
  • Platelet Aggregation Inhibitors / therapeutic use
  • Recombinant Proteins / adverse effects
  • Recombinant Proteins / economics
  • Recombinant Proteins / therapeutic use
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • United States / epidemiology
  • Young Adult

Substances

  • Anticoagulants
  • Antithrombins
  • Hirudins
  • Peptide Fragments
  • Platelet Aggregation Inhibitors
  • Recombinant Proteins
  • Heparin
  • bivalirudin