@article {516486,
	title = {Bivalirudin therapy is associated with improved clinical and economic outcomes in ST-elevation myocardial infarction patients undergoing percutaneous coronary intervention: results from an observational database},
	journal = {Circ Cardiovasc Qual Outcomes},
	volume = {5},
	number = {1},
	year = {2012},
	month = {2012 Jan},
	pages = {52-61},
	abstract = {BACKGROUND: Randomized trials show improved outcomes among acute coronary syndrome patients treated with bivalirudin. The objective of this analysis was to compare clinical and economic outcomes in ST-elevation myocardial infarction (STEMI) patients encountered in routine clinical practice undergoing primary percutaneous coronary intervention (PPCI), treated with bivalirudin or heparin+GP IIb/IIIa receptor inhibitor (heparin+GPI).

METHODS AND RESULTS: STEMI admissions from January 1, 2004 through March 31, 2008 among patients receiving PPCI and bivalirudin or heparin+GPI in the Premier hospital database were identified. The probability of receiving bivalirudin was estimated using individual and hospital variables; using propensity scores, each bivalirudin patient was matched to 3 heparin+GPI treated patients. The primary outcome was in-hospital death. Rates of bleeding, transfusion, length of stay, and in-hospital cost were secondary outcomes. There were 59,917 STEMI PPCIs receiving bivalirudin (n=6735) or heparin+GPI (n=53,182). Seventy-nine percent of bivalirudin patients matched, resulting in 21,316 STEMI PPCIs for analysis. Compared with heparin+GPI patients, bivalirudin patients had fewer deaths (3.2\% versus 4.0\%; P=0.011) and less inpatient bleeding (clinically apparent bleeding [6.9\% versus 10.5\%, P,
	keywords = {Acute Coronary Syndrome, Adolescent, Adult, Aged, Aged, 80 and over, Angioplasty, Antithrombins, Coronary Vessels, Cost-Benefit Analysis, Electrocardiography, Female, Hemorrhage, Heparin, Hirudins, Humans, Male, Middle Aged, Myocardial Infarction, Peptide Fragments, Platelet Glycoprotein GPIIb-IIIa Complex, Recombinant Proteins, Retrospective Studies, Survival Analysis, Treatment Outcome, Young Adult},
	issn = {1941-7705},
	doi = {10.1161/CIRCOUTCOMES.111.961938},
	author = {Pinto, Duane S and Ogbonnaya, Augustina and Sherman, Steven A and Tung, Patricia and Normand, Sharon-Lise T.}
}
