• Am J Emerg Med · Jan 2012

    Prehospital treatment of patients with acute myocardial infarction with bivalirudin.

    • Michael M Hirschl, Harald Mayr, Friedrich Erhart, Walter Brunner, Friedrich Steger, Martin Gattermeier, and Franz Pfeffel.
    • 3rd Medical Department, Landesklinikum St. Pölten, A-3100 St. Pölten, Austria. michael.hirschl@zwettl.lknoe.at
    • Am J Emerg Med. 2012 Jan 1;30(1):12-7.

    ObjectivesPatients with acute myocardial infarction are at high risk of dying within the first hours after onset of coronary ischemia. Therefore, pharmacological intervention should be started in the prehospital setting. This study investigates the effect of the prehospital administration of bivalirudin on short-term morbidity and mortality compared to heparin plus abciximab in patients with ST-segment-elevation myocardial infarction (STEMI).MethodsOne hundred ninety-eight patients with STEMI treated with bivalirudin in the prehospital setting were prospectively collected. Coronary angiography was performed to identify the infarct-related artery. In case of a percutaneous coronary intervention, bivalirudin was given according to the guidelines. The historic control group consisted of 171 consecutive patients from the same myocardial infarction network treated with unfractioned heparin and abciximab administration before the admission to the emergency department of the percutaneous coronary intervention center. The primary outcome parameter was the incidence of major adverse cardiac events (recurrent myocardial infarction, stroke, death, target vessel revascularization for ischemia) within 30 days after the primary event.ResultsThe overall rate of major adverse cardiac events was significantly lower in the bivalirudin group compared to the abciximab group (7.6% vs 14.6%; P = .04). The number of major bleedings was significantly higher in the abciximab group compared to the bivalirudin group (11.8% vs 3.8%; P = .03).ConclusionsThe use of bivalirudin in the prehospital setting leads to a reduced rate of major cardiovascular events compared to a standard treatment with abciximab plus heparin. Bivalirudin is a reasonable choice of treatment in the prehospital setting for patients with STEMI.Copyright © 2012 Elsevier Inc. All rights reserved.

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