Myocardial Damage After ST-Segment Elevation Myocardial Infarction According to the Use of Bivalirudin or Heparin
A Cardiac Magnetic Resonance Substudy of the DANAMI3 trial
Mikkel M Schoos1, ; Lars Nepper-Christensen2; Kiril A. Ahtarovski2; Kasper Kyhl2; Christoffer Göransson2; Lene Holmvang2; Henning Kelbæk3; Steffen Helqvist2; Dan E Høfsten2; Lars Køber2; Niels Vejlstrup2; Jacob Lønborg2; Thomas Engstrøm2;
1. Department of Cardiology, Zealand University Hospital University Hospital, Denmark, 2. Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark 3. Department of Cardiology, Zealand University Hospital, Denmark
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The benefits of bivalirudin or UFH during primary PCI remain controversial. Bivalirudin rather than UFH plus routine GPI has been shown to improve overall and cardiac survival and reduced bleeding complications in patients undergoing primary PCI. Several trials comparing bivalirudin and UFH ± GPI have since questioned this survival advantage and created controversy related to bivalirudin-associated improved bleeding outcome and the risk of acute stent thrombosis. Recently, the VALIDATE-SWEDEHEART Bivalirudin versus Heparin Monotherapy in Myocardial Infarction during PCI trial reported no differences in myocardial infarction, major bleeding, definite stent thrombosis and death.(1) Clinically meaningful reduced efficacy of either regimen in antithrombotic protection during primary PCI is likely to lead to increased myocardial damage. The present analysis evaluated therefore myocardial salvage, infarct size, MVO and LVEF by CMR, according to the antithrombotic strategy.