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

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Abstract

Objective

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.

Results

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).

Conclusion

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.

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Authors and Affiliations

  1. Herz-Kreislauf-Zentrum, Segeberger Kliniken GmbH, Bad Segeberg, Germany

    Ahmed A. Khattab & Gert Richardt

  2. Deutsches Herzzentrum, Technische Universität, Munich, Germany

    Gjin Ndrepepa, Stefanie Schulz, Julinda Mehilli, Jürgen Pache, Melchior Seyfarth, Adnan Kastrati & Albert Schömig

  3. Herzzentrum, Bad Krozingen, Germany

    Franz-Josef Neumann & Heinz Joachim Büttner

  4. Medizinische Klinik rechts der Isar, Technische Universität, Munich, Germany

    Josef Dirschinger & Albert Schömig

  5. Geisinger Medical Center, Danville, USA

    Peter B. Berger

  6. Cardiology Department, University Hospital, 3010, Bern, Switzerland

    Ahmed A. Khattab

Authors
  1. Ahmed A. Khattab
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  2. Gjin Ndrepepa
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  3. Stefanie Schulz
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  4. Franz-Josef Neumann
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  5. Julinda Mehilli
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  6. Heinz Joachim Büttner
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  7. Jürgen Pache
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  8. Melchior Seyfarth
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  10. Adnan Kastrati
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  11. Peter B. Berger
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  13. Gert Richardt
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Correspondence to Ahmed A. Khattab.

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Khattab, A.A., Ndrepepa, G., Schulz, S. et al. Statin effect on thrombin inhibitor effectiveness during percutaneous coronary intervention: a post-hoc analysis from the ISAR-REACT 3 trial. Clin Res Cardiol 100, 579–585 (2011). https://doi.org/10.1007/s00392-011-0282-7

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  • DOI: https://doi.org/10.1007/s00392-011-0282-7

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