Primary per-coetaneous coronary intervention (PPCI) is the treatment of choice in patients with acute ST elevation myocardial infarction (STEMI). In PPCI patients, bivalirudin, caused less bleeding complications and was equivalent in efficacy to combined treatment with heparin and IIb IIIa antagonist.
Aim: Compare the effects of bivalirudin and heparin on coronary flow, microcirculation and recovery of left ventricular systolic function in patients with acute STEMI undergoing PPCI.
Methods: Forty five patients with acute anterior STEMI undergoing PPCI, 30 treated with heparin and 15 with bivalirudin were compared. All patients had complete trans-thoracic Doppler echocardiographic studies and sampling of blood velocities in the left anterior descending coronary artery (LAD) early after PPCI and 5 days later.
Results: TIMI and myocardial blush grades were similar in both groups before after PPCI. Peak LAD diastolic velocities early after PPCI were higher in the bivalirudin group 42.2±14.4 compared to the heparin group 34.06±8.27 cm/sec, p0.03. Peak velocities in the LAD did not change significantly on follow up in both groups. Early diastolic velocity integrals in the LAD in patients treated with bivalirudin, 12.3±4.2 were higher than in those treated with heparin, 8.91±3.21 cm, p0.02, and this difference between the groups was maintained on late evaluation. Left ventricular ejection fraction was similar in both treatment groups early and late after PPCI.
Conclusions: Bivalirudin treatment in patients with acute anterior STEMI treated with PPCI was associated with higher LAD velocities and integrals compared to heparin. Bivalirudin did not affect TIMI and myocardial blush grades and did not affect left ventricular systolic function in these patients.
