Percutaneous Coronary Intervention
Research on anticoagulation, antiplatelet therapy, and procedural outcomes during and after percutaneous coronary intervention (PCI/angioplasty) including stent placement.
Quick Answer
What it is
Research on anticoagulation, antiplatelet therapy, and procedural outcomes during and after percutaneous coronary intervention (PCI/angioplasty) including stent placement.
Key findings
- Grade A: Major Bleeding Reduction (Bivalirudin)
- Grade A: Net Adverse Clinical Events (Bivalirudin)
- Grade A: Death/MI After PCI Stenting (Eptifibatide (Integrilin))
Safety
- 37% relative risk reduction.
ℹ️ Quick Facts
Quick Facts: Percutaneous Coronary Intervention
- Supplements Studied:2
2 supps · 5 outcomes
Detailed Outcomes
A
Major Bleeding Reduction
HORIZONS-AMI: Major bleeding 4.9% vs 8.3% with heparin+GPI (P<0.001). ACUITY: 47% relative reduction in major bleeding. REPLACE-2: Significantly lower bleeding with bivalirudin monotherapy. Consistent across 25,000+ patients in pooled analyses.
large↓Improves
A
Net Adverse Clinical Events
HORIZONS-AMI: NACE 9.2% vs 12.1% with heparin+GPI at 30 days. ACUITY: Similar ischemic outcomes with reduced bleeding. 1-year follow-up confirmed sustained benefit. Net clinical benefit driven primarily by bleeding reduction.
moderate↓Improves
B
Mortality
HORIZONS-AMI: 1-year all-cause mortality 3.5% vs 4.8% (P=0.037). Cardiac mortality 2.1% vs 3.1% (P=0.047). VALIDATE-SWEDEHEART: No mortality difference vs heparin alone at 180 days. Mortality benefit may relate to bleeding reduction.
moderate↓Improves
B
Acute Stent Thrombosis
SAFETY CONCERN: HORIZONS-AMI: Higher acute stent thrombosis within 24h (1.3% vs 0.3%, P<0.001). HEAT-PPCI: Stent thrombosis 3.4% vs 0.9% with heparin. Mitigated by post-PCI bivalirudin infusion (BRIGHT trial). ESC guidelines downgraded to Class IIb in 2018.
small↓Worsens
A
Death/MI After PCI Stenting
ESPRIT (n=2,064): Death/MI/TVR 7.5% vs 11.5% at 6 months (HR 0.63, P=0.002). MI reduced at 48h from 9% to 5.4% (P=0.0015). 37% relative risk reduction. Double-bolus regimen.
moderate↓Improves