Bivalirudin no better than heparin?
There was a 34% relative risk reduction (P less than .001) in the primary composite endpoint at the end of 180 days of follow-up “after adjusting basically for all of the important differences that might affect risk,” Dr. Omerovic reported. The long list included type of acute coronary syndrome, age, hypertension, diabetes, and history of vascular events or prior procedures.
Radial access was also linked with a 59% lower risk of mortality and a 43% lower risk of major bleeding (both P less than .001) when compared with femoral access, according to Dr. Omerovic. He attributed most of the difference in bleeding to bleeding events at the access site.
Baseline differences between the two groups indicated that patients undergoing PCI with femoral access were a higher-risk group. Femoral patients had higher rates of diabetes, hyperlipidemia, and hypertension (all P less than .001). They were also older, more likely to be in Killip class II or above, and more likely to have history of prior MI, prior stroke, and prior coronary artery bypass grafting (also all P less than .001).
Dr. Omerovic maintained that proper adjustment was made for these confounders. He also defended his conclusion that radial access should be preferred over femoral access by stressing that the data regarding this question, including those from other studies and from registries, are uniformly consistent. “They all go in the same direction,” he said.