Clinical Research in Cardiology

, Volume 100, Issue 7, pp 579–585

Statin effect on thrombin inhibitor effectiveness during percutaneous coronary intervention: a post-hoc analysis from the ISAR-REACT 3 trial


    • Herz-Kreislauf-ZentrumSegeberger Kliniken GmbH
    • Cardiology DepartmentUniversity Hospital
  • Gjin Ndrepepa
    • Deutsches HerzzentrumTechnische Universität
  • Stefanie Schulz
    • Deutsches HerzzentrumTechnische Universität
  • Franz-Josef Neumann
    • Herzzentrum
  • Julinda Mehilli
    • Deutsches HerzzentrumTechnische Universität
  • Heinz Joachim Büttner
    • Herzzentrum
  • Jürgen Pache
    • Deutsches HerzzentrumTechnische Universität
  • Melchior Seyfarth
    • Deutsches HerzzentrumTechnische Universität
  • Josef Dirschinger
    • Medizinische Klinik rechts der IsarTechnische Universität
  • Adnan Kastrati
    • Deutsches HerzzentrumTechnische Universität
  • Peter B. Berger
    • Geisinger Medical Center
  • Albert Schömig
    • Deutsches HerzzentrumTechnische Universität
    • Medizinische Klinik rechts der IsarTechnische Universität
  • Gert Richardt
    • Herz-Kreislauf-ZentrumSegeberger Kliniken GmbH
Original Paper

DOI: 10.1007/s00392-011-0282-7

Cite this article as:
Khattab, A.A., Ndrepepa, G., Schulz, S. et al. Clin Res Cardiol (2011) 100: 579. doi:10.1007/s00392-011-0282-7



To determine whether statin therapy influences the efficacy of thrombin inhibitor bivalirudin or unfractionated heparin (UFH) during PCI.

Setting and patients

The post-hoc analysis of the ISAR-REACT 3 Trial included 4,570 patients: 3,106 patients were on statin therapy and 1,464 patients were not on statin therapy at the time of PCI procedure.

Main outcome measures

The primary outcome of this analysis was the 30-day composite of death, myocardial infarction, target vessel revascularization (TVR) or major bleeding.


The primary outcome occurred in 7.9% patients (n = 246) in the statin group versus 9.8% (n = 143) in the non-statin group (P = 0.036). There was an interaction in univariate (P = 0.028) and multivariable (P = 0.026) analysis between pre-PCI statin therapy and the type of antithrombotic therapy regarding myocardial infarction. In the statin group, bivalirudin significantly reduced the incidence of major bleeding (2.6 vs. 4.3%, P = 0.013) with no significant difference in the incidence of myocardial infarction (4.9 vs. 5.2%; P = 0.73) compared with UFH. In the non-statin group, bivalirudin was inferior to UFH regarding the incidence of myocardial infarction (7.1 vs. 4.1%, P = 0.013), yet major bleeding remained lower among bivalirudin-treated patients (4.0 vs. 5.2%, P = 0.25).


This post-hoc analysis suggests the existence of an interaction between statin therapy before PCI and antithrombotic therapy during PCI. Patients receiving bivalirudin therapy at the time of PCI showed less periprocedural myocardial infarction when on pre-PCI statin therapy which has to be investigated in further studies.



Copyright information

© Springer-Verlag 2011