Qaderdan et al. – This pooled analysis study of 2 large randomized trials, the EUROMAX and HORIZONS–AMI, compared the outcomes in elderly and young patients who underwent primary percutaneous coronary intervention (pPCI) for ST–segment elevation myocardial infarction (STEMI). The patients randomly received either bivalirudin or heparin. The results demonstrated that treatment with bivalirudin in elderly patients was associated with lower 30–day rates of non–coronary artery bypass grafting (CABG) major bleeding, subacute stent thrombosis (ST), and net adverse clinical events (NACEs) with similar 30–day rates of acute ST and mortality, versus heparin with or without glycoprotein IIb/IIIa inhibition (GPI).

Methods

• A patient–level pooled analysis of 2 randomized trials, EUROMAX and HORIZONS–AMI (N = 5800), was performed.
• A total of 2149 elderly patients (>65 years of age) with STEMI randomly received either bivalirudin or heparin with or without a GPI (control group) prior to pPCI.
Clinical outcomes at 30 days were analyzed.

Results

• In elderly patients, treatment with bivalirudin significantly reduced non–CABG major bleeding (7.1% vs 10.4%), subacute ST (0.4% vs 1.5%), and NACE (composite of all–cause mortality, reinfarction, ischemia–driven revascularization, stroke or protocol–defined non–CABG major bleeding [13.7% vs 17.2%]) with similar rates of stroke, myocardial infarction, acute ST, or all–cause mortality, compared with heparin with or without GPI.