European Heart Journal Advance Access originally published online on October 7, 2005
European Heart Journal 2005 26(22):2396-2403; doi:10.1093/eurheartj/ehi590
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Direct thrombin inhibitors in acute coronary syndromes: effect in patients undergoing early percutaneous coronary intervention
1Duke Clinical Research Center, Durham, NC, USA
2Department of Cardiology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
3NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
4Department of Cardiology, Population Health Research Institute, McMaster University, Hamilton, Ont., Canada
5Department of Medicine, McMaster University, Hamilton, Ont., Canada
6Ocala Heart Institute, Munroe Regional Medical Center, Ocala, FL, USA
7Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
8Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA
Received 20 May 2005; revised 15 September 2005; accepted 22 September 2005; online publish-ahead-of-print 7 October 2005.
* Corresponding author. E-mail address: peter.sinnaeve{at}uz.kuleuven.ac.be
See page 2354 for the editorial comment on this article (doi:10.1093/eurheartj/ehi554)
This paper was guest edited by Prof. Freek W.A. Verheugt, University Medical Center Nijmegen, The Netherlands
Aims We evaluated the effect of direct thrombin inhibitors (DTIs) in patients undergoing early percutaneous coronary intervention (PCI), using the DTI Trialists' Collaboration database of 35 970 patients from 11 randomized trials of DTIs vs. heparin.
Methods and results We performed a Cox proportional hazards regression analysis with PCI as a time-dependent covariate to assess the independent impact of DTIs according to the performance of early PCI. PCI was performed in 7049 patients in the first 72 h after randomization. In trials in which PCI was not planned, DTIs were associated with a 10% relative risk reduction in death or myocardial infarction at 30 days (HR=0.90, 95% CI: 0.84–0.97). This benefit was found to be greater in patients undergoing early PCI (HR=0.66, 95% CI: 0.48–0.91) than those undergoing non-early PCI (HR=0.94, 95% CI: 0.86–1.03). After adjustment for baseline characteristics and propensity to undergo PCI, the risk of death or myocardial infarction remained lower with DTI (HR=0.62, 95% CI: 0.44–0.89).
Conclusion After adjustment for baseline differences and propensity to undergo early PCI, DTIs appeared to be more effective than heparin in reducing death or re-infarction among patients undergoing early PCI.
Key Words: Direct thrombin inhibitors • Percutaneous coronary intervention • Acute coronary syndromes
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- Direct thrombin inhibitors in acute coronary syndrome patients undergoing percutaneous coronary intervention: special effects in selected patients?
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