• Heyang Wang, Yi Li, Hongliang Cong, Shifang Ding, Bin Liu, Lu Li, Yundai Chen, Shaobin Jia, Quanmin Jing, Xin Zhao, Haiwei Liu, Zhenyang Liang, Jing Li, Dan Bao, and Yaling Han.
• Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016, China.
• Catheter Cardiovasc Interv. 2017 Jun 1; 89 (7): 1157-1165.

ObjectivesTo explore the efficiency and safety of bivalirudin in patients undergoing emergency percutaneous coronary intervention via radial access.BackgroundBivalirudin reduces bleeding risks over heparin in patients undergoing PCI. However, bleeding advantages of bivalirudin in patients undergoing transradial intervention is uncertain.MethodsIn the BRIGHT trial, 1,723 patients underwent emergency PCI via radial access, with 576 patients in the bivalirudin arm, 576 in the heparin arm and 571 in the heparin plus tirofiban arm. The primary outcome was 30-day net adverse clinical event (NACE), defined as a composite of major cardiac and cerebral events or any bleeding.Results30-day NACE occurred in 5.7% with bivalirudin, 7.8% with heparin alone (vs. bivalirudin, P = 0.159), and 10.3% with heparin plus tifofiban (vs. bivalirudin, P = 0.004). The 30-day bleeding rate was 0.9% for bivalirudin, 2.3% for heparin (vs. bivalirudin, P = 0.057), and 5.8% for heparin plus tirofiban (vs. bivalirudin, P < 0.001). Major cardiac and cerebral events (4.9 vs. 5.7 vs. 4.6%, P = 0.899), stent thrombosis (0.5 vs. 0.5 vs. 0.7%, P = 0.899) and acquired thrombocytopenia (0.2 vs. 0.5 vs. 0.9%, P = 0.257) at 30 days were similar among three arms. The interaction test for PCI access and randomized treatment showed no significance on all bleeding (P > 0.05).ConclusionsThe bleeding benefit of bivalirudin was independent of artery access. Bivalirudin lead to statistical reduction on bleeding risks in comparison to heparin plus tirofiban, and only small numerical difference in comparison to heparin, with comparable risks of ischemic events and stent thrombosis in patients with acute myocardial infarction (AMI) undergoing emergency transradial PCI. © 2016 Wiley Periodicals, Inc.© 2016 Wiley Periodicals, Inc.

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