简介：ObjectivesToinvestigatethechangeandclinicalsignificanceofclopidogrelonplateletmembraneCD40Lincoronaryarterydiseasepatientsbeforeandafterpercutaneouscoronaryintervention(PCI).Methods30caseswhowerediagnosiscoronaryarterydiseases(CAD)bycoronaryangiography,meanage56±9yearsold.Allthepatientswhohadnoantiplateletaggregationcontraindication,weretreatedwithstandardantianginapectorisdrugs.BeforePCI,allthepatientstookclopidogrel75mgperday.ActivatedplateletmembraneCD40LexpressratewasmeasuredbyflowcytometrybeforeandafterPCI6hours.ResultsActivatedplateletmembraneCD40Lexpressratewere3.73±2.15and2.46±0.90,respectivelyin30patientsbeforeandafterPCI6hours.ActivatedplateletmembraneCD40LexpressratewassignificantlydecreaseafterPCI6hoursthanthatbeforePCI(P<0.01).ConclusionsClopidogrelhassignificanceeffectonplateletmembraneCD40LincoronaryarterydiseasepatientsundergoingPCI.Clopidogrelcansuppressionplateletactivationandpreventthromboembolismeventoccurrence.

简介：BackgroundTheCHA2DS2-VAScschemahasrecentlybeenintroducedtocomplementtheCHADS2scoreandimprovetheidentificationofatrialfibrillation(AF)patientsat'trulylowrisk'forthromboembolism.WetestedthepredictiveabilityoftheCHA2DS2-VASc,CHADS2andvanWalravenriskstratificationschemesinacohortof'lone'AFpatientswitha12-yearfollow-up.MethodsandResultsWeconductedaregistry-based,observationalcohortstudyof345patientsinitiallydiagnosedwith'lone'AFbetween1992and2007.Atbaseline,allpatientshadtheCHADS2andvanWalravenscoresof0,and262(75.9%)hadaCHA2DS2VAScscore=0.Duringfollow-up(orwithinayearpriortostroke),228(66.1%),234(67.8%)and150patients(43.5%)retainedtheCHADS2,vanWalravenandCHA2DS2VAScscoresof0,respectively.Theoverallrateofischemicstrokewas0.19(95%CI:0.18-0.20)per100patient-years.Inthemultivariableanalysis,onlytheCHA2DS2-VAScscoreof0wassignificantlyrelatedtotheabsenceofstroke(OR5.1,95%CI:1.5-16.8,P=0.008).OnlytheCHA2DS2-VAScscorehadasignificantpredictionability(c-statistic0.72[0.61-0.84],P=0.031).ConclusionsTheCHA2DS2-VAScscorereliablyidentifiedthe'lone'AFpatientswhowereat'trulylowrisk'forthromboembolism,andwastheonlytestedriskstratificationschemewithasignificantpredictiveabilityforthromboembolismamongstloneAFpatients.

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简介：BackgroundThepresenceofachronictotalocclusion(CTO)inanon-infarct-relatedarterymightbeassociatedwithaworseprognosisinlongtermbenefitforST-segmentelevationmyocardialinfarction(STEIMI)patients.Butitstillremaincontroversial.MethodsAll383STEMIpatientsunderwentpercutaneousintervention(PCI)fromJan2015toJan2017inourcenterwereenrolledinthisprospectivestudy.Baselinecharacteristics,medicalhistory,biochemicalfindings,echocardiographicandangiographicparameters,proceduresperformedandcomplicationswererecorded.FactorsrelatedtoworseoutcomeCTOinSTEMIpatientswereanalyzedbythecoxlogisticregressionanalysisforthehazardrate(HR).ResultsInatotalof383patientsenrolledinthisstudy,85caseshadCTOinatleast1coronaryartery.Themeanfollow-upwas352days.1-yearmortalityandMACEratesinpatientswithCTOwere18.8%and11.8%,respectively.Majoradversecardiacevents(MACE)duringfollow-upweresignificantlyhigherinpatientswithCTO(HR=2.88;95%CI,1.82-4.77;P<0.001).ThemultivariateanalysisshowedasignificantassociationbetweenCTOandMACE(HR=2.1195%CI,1.27-3.88;P=0.014).ConclusionChronictotalocclusionisassociatedwithhigherriskofcomorbiditiesandhighermortality,andservesasanindependentpredictorofMACE.

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简介：Catheterablationofpersistentatrialfibrillation(AF)remainsachallengingtask.Thelong-termclini-caloutcomeandpredictorsfortherecurrenceofatrialarrhythmiasafterablationhasnotbeenconsistent.MethodsWeanalyzedtheclinicaloutcomeof103consecutivepatientswithafollow-up>12monthswhounderwentcatheterablationforpersistentAF.Westudiedtheirclinicaldataintermsofage,AFduration,concomitantdieases(hypertension,dia-betesormitralinsuffciency),leftatrialdiameter,catheterablationstrategies(circumferentialpulmonaryveinablation,complexablation)andthefollow-uprhythm.COXproportionalhazardmultivariateregressionanalysiswasperformedtoidentifythepredictorsofrecurrentatrialarrhythmiasafterablation.ResultsTherewere85malesand18femaleswithameanageof55.5±11.9yearsold.Afterafollowing-upof26.7±13.8months(12-61),89patients(86.4%)remainedsinusrhythm(SR),including67(65.0%)undergoingsingleprocedure,2(1.9%)withrecurrentatrialtachycardia(AT)undergoingsuccessfulcardioversionbydrug(amiodarone),and20undergoingre-ablation.Fourteenfailurecasesincluded8unsuccessfulpatientswithchronicAFwhorefusedre-ablation,5failurecasesafterre-ablationand1remainingAFaftersurgicalablation.Thesuccessfulrateofrepeatprocedurewas76.9%(20/26).COXregressionanalysisindicatedthatthepredictorsforrecurrencewerehypertension(OR=8.251,P=0.024),1AFdura-tion(OR=1.108,P=0.013),andmitralinsufficiency(OR=8.982,P=0.009).Complexablationstrategy(cir-cumferentialpulmonaryveinablation+lineablation+CFAE+linearablationalongtheatrialsideofcoronarysinus)decreasedtheriskofrecurrence(OR=0.004,P=0.009).ConclusionsSuccessfulrateofablationforpersistentAFafterthefirst12monthswashigh.Repeatprocedurecouldfurtherimprovethesinusrate.Hypertension,AFdurationandmitralinsuffciencywereindependentpredictorsofrecurrentatrialarrhythmiasafterpersisten

简介：ObjectivesTocomparethedifferenteffectsoflatesuccessfulreperfusionwithPCIonleftventricularfunctionanditsrelationshipwithviablemyocardiumafteracuteanteriorwallmyocardialinfarctioninpatientswithorwithoutdiabetes.MethodsAtotalof125consecutivesubjectswithacuteanteriorwallmyocardialinfarctionwereselected,anddividedintodiabetesmellitus(DM)group(n=43)andNon-DMgroup(n=82)accordingtoWHOdiabetesdiagnosiscriteria.AllpatientsreceivedsuccessfulPCIat12±8daysfromonset.Ischemicviablemyocardiumwasdetectedwithlow-dosedobutamineechocardiography,andleftventricularfunctionandwallmotionabnormalitywerealsoassessedwithechocardiographybeforePCI.ThedataofclinicalmanifestationsandangiogramsbeforeandafterPCIwereanalyzed.Levelsofcreatininekinase-MB(CK-MB),andtroponinT(TnT)beforePCI,6hoursand24hoursafterPCIwereassessed.Allpatientsreceivedclinicandechocardiographyfollow-upfor6months.ResultsHigherrateofTIMI2flow,andlowerrateofTIMI3flowinDMgroupweredemonstratedimmediatelyafterPCI,andtherateofserumCK-MBand/orTnTlevelswerehigherinDMgroup,comparedwithNon-DMgroup(P<0.05).63%ofDMpatientsand56%ofnon-DMpatientshadviablemyocardiumbeforePCI(P>0.05).Therewerenosignificantdifferencesofleftventricularejectionfraction(LVEF),leftventricularenddiastolicvolumeindex(LVEDVI),leftventricularendsystolicvolumeindex(LVESVI),andwallmotionscore(WMS)betweentwogroupsatbaselinebeforePCI(P>0.05).Aftersixmonths,WMSwasdecreasedandLVEFwasincreasedinNon-DMgroup,buttheWMSandtheLVEFdidnotchanged,andtheLVEDVIwasincreasedinDMgroupcomparedwithbaseline;theLVEDVI,LVESVI,LVEF,andWMSweresignificantlydifferentbetweentwogroups(P<0.05orP<0.01).ConclusionsComparedwithnon-diabetics,delayedsuccessfulrevascularizationwithPCIindiabeticspatientwithacutemyocardialinfarctionhaslessbenefitialeffectontheimprovementoflatephasel

简介：BackgroundTotheeffectofpercutaneouscoronaryintervention(PCI)onplasmalevelofN-terminalpro-Btypenatriureticpeptide(NT-proBNP)inpatientswithcoronaryheartdisease(CHD)andnormalleftventricularfunction.MethodsOnehundredandfivepatientswithCHDandnormalventricularfunctionwereenrolled.BloodsamplesforassessmentofNT-proBNPandcTn-TwerecollectedbeforeandafterPCI.ResultsThemeanleftventricularejectionfractionwas60.3±5.3%.Afterrevascularization,theleveloflgNT-proBNPwassignificantlyreduced(2.40±0.44vs2.23±0.43,P<0.001).SubgroupanalysisshowedthattheleveloflgNT-proBNPwasconsistentlydecreasedindifferentclinicalclassifications(stableangina45,unstableangina31andacutemyocardialinfarction29)andtarget-vesselrevascularization(leftanteriordescendingartery30,leftcircumflexartery26andrightcoronaryartery49),andin99patientswithoutelevationofpost-proceduralcTnT,butitshowedatrendofnon-significantincreasein6patientswithelevatedcTn-T.ConclusionsOurstudydemonstratesthatsuccessfulPCIreducesplasmaNT-proBNPconcentrationinpatientswithCHDandnormalventricularfunction.ThisimplicatesthattheimpactofPCIshouldbeconsideredintheinterpretationofNT-proBNPchangeinclinicalpractice,andfurtherstudiesarenecessarytoinvestigatethedirectand/orindirecteffectofmyocardialischemiaonBNP/NT-proBNP.

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简介：BackgroundMonocytetohighdensitylipoproteinratio(MHR)hasbeenconsideredasanovelparameterrelatedwithadverserenalandcardiovascularoutcomes.InthisstudyweinvestigatedtheassociationofMHRwithmajoradverseclinicalevents(MACEs)inpatientswithtype2diabetesmellitus(T2DM)undergoingelectivepercutaneouscoronaryintervention(PCI).MethodsConsecutiveT2DMpatientstreatedwithelectivePCIwereprospectivelyrecruitedbetweenJuly2008-January2016inDepartmentofCardiologyofPanyuCentralHospital.Subjectswerecategorizedintotwogroups:aspatientswhodevelopedMACEs(MACEs+)andpatientswhodidnotdevelopMACEs(MACEs-)duringhospitalization.MACEsweredefinedasthecompositeendpoints,includingall-causemortality,oracuteheartfailure,ortargetvesselrevascularization,orstrokeorrecurrentangina.ResultsAtotalof418patientswereincludedinthestudy.64patientsdevelopedMACEs(15.3%).IntheMACEs(+)patients,monocyteswerehigher(1.12[0.78-1.42]vs.0.72[0.68-0.92]109/L,P<0.01)andHDLcholesterollevelswerelower(0.87[0.72-1.21]vs.0.96[0.81-1.11]mmol/L,P<0.01).Inaddition,MHRwassignificantlyhigherintheMACEs(+)group(1.12[0.91-2.09]vs.0.73[0.54-0.93]109mmol/L,P<0.01).ThecutoffvalueofMHRforpredictingMACEswas22,withasensitivityof81%andaspecificityof75.1%(areaunderthecurve0.79,P<0.001).Inmultivariatelogisticregressionanalysis,MHRremainedanindependentfactorcorrelatedwithMACEs(OR=3.97,95%CI=1.38-11.5,P<0.01).ConclusionHigherMHRlevelsmaypredictMACEsdevelopmentafterelectivePCIinT2DMpatients.

简介：BackgroundSepticshockcausedbybacteremiaisalife-threateninginfectionwhoseprognosisishighlydependentonearlyrecognitionandappropriatetreatment.Procalcitonin(PCT)hasbeenshowntoaccuratelyandquicklydistinguishbacteremiafromnoninfectiousinflammatorystatesincriticallyseverepatients.However,theextentofPCTmagnitudeelevationaccordingtotheGramstainresultinelderlypatientswithcoronaryheartdisease(CHD)attheonsetofsepticshockcausedbybacteremiavaries,andhasnotbeenclearlyelucidated.MethodsThemedicalrecordsofadvancedage(non-neutropenic)patientwithCHDandsepticshockbetweenMar2013andJun2015whohadbacteremiacausedbyeitherGram-positive(GP)bacteriaorGram-negative(GN)bacteriawerereviewed,andthelevelsofPCT,C-reactive(CRP)proteinandwhitebloodcellscount(WBC)inbothgroupswereanalyzed.Results75episodesofeitherGNbacteremia(n=40)orGPbacteremia(n=35)wereenrolled.PCTlevelswerefoundtobemarkedlyhigherinpatientswithGNbacteremiathaninthosewithGPbacteremia[(8.93±17.58)vs.(64.42±58.56)ng/L(P<0.001)],whereastherewasnosignificantdifferenceinCRPandWBC(P>0.05).Moreover,ahighPCTlevelwasfoundtobeindependentlyassociatedwithGNbacteremiainthisstudypopulation.APCTlevelof19.69ng/mLyieldeda72.5%sensitivity,a91.4%specificity,an8.43positivelikelihoodratioanda0.30negativelikelihoodratioforGN-relatedbacteremiainthestudycohort[AUROCC=0.870(0.041),95%CI(0.790-0.949)].ConclusionInanelderlypatient(non-neutropenic)withCHDandsepticshock,GNbacteremiacouldbeassociatedwithhigherPCTvaluesthanthosefoundinGPbacteremia(PCT>19.69ng/mL).

简介：BackgroundRightbundlebranchblock(RBBB)maypresentasslurredornotchedSwaveinleadV1.However,slurredornotchedSwavemayalsorepresentslowconductioninthemyocardium.MethodsWeretrospectivelyanalyzedtheQRSpatternsinleadsV3RtoV5Rin7patientswithaslurredornotchedSwaveinleadV1.ResultsIntheleadsV3RtoV5R,6patientsshowedincompleteorcompleteRBBBand1patientslurredornotchedSwave.ConclusionsInthemajorityofECGsinasmallpatientserieswithslurredornotchedSwaveinleadV1,QRSmorphologyindicatingincompleteorcompleteRBBBwaspresentinleadsV3RtoV5R.AfindingoffragmentedQRSintheseleadsmayindicateslowconductioninthemyocardium.

简介：BackgroundComparedtoclopidogrel,Ticagrelorsignificantlyreducestheriskofcardiovasculareventsinpatientswithacutemyocardialinfarction(AMI)howeverincreasestheincidenceofbleedingandtheriskoffatalintracranialhemorrhage.Inthisstudy,wescreenedtheAMIpatientswithclopidogrelresistence,anddeterminedwhetherticagrelorsequentialtherapycouldreducetheriskofcardiovasculareventsandbleedingrisk.MethodsAtotalof319AMIpatientswereenrolledinthisprospectiveclinicalstudy.Theplateletinhibitionratesinadenosine5'-diphosphate(ADP)pathwaysweremeasuredbyathrombelastography(TEG)system.ThepatientswithclopidogrelresistanceweredividedintoTicagrelorsequentialtherapygroup(ticagrelorfor3monthsandclopidogrelfor9months,n=143)andClopidogrelgroup(clopidogrelfor12months,n=176).Theriskofmajoradversecardiacevents(MACE)andthesafetyendpointsat1-yearfollow-upwereanalyzed.ResultsTheratesofstentthrombosis(ST)(2.1%vs.8.0%,P=0.017)orMI(2.8%vs.10.2%,P=0.009)werelowerintheticagrelorsequentialtherapygroupthanintheclopidogrelgroup.Dyspneawasmoreoftenintheticagrelorsequentialtherapygroupthanintheclopidogrelgroup(17.5%vs.4.5%,P<0.001).Nosignificantdifferenceintherateofmajorbleedingwasfoundbetweenthegroups(3.4%vs.3.9%,P=0.528).ConclusionsInAMIpatientswithhyporesponsivenesstoclobidogrelticagrelorsequentialtherapygroupsignificantlydecreasedtheratesofSTandMIwithoutincreasedriskofmajorbleedingascomparedwithclopidolgrel.

简介：BackgroundTheearlyendothelialdysfunctionofcarotidarteryinpatientswithtype2diabetesmellitus(T2DM)hasbeenrecognized.However,thefeasibilityandsignificanceofcarotidarteryendothelialdysfunctiondetectedbyultrasoundradio-frequencytechnologyhasbeenseldomstudied.MethodsThe2Dultrasoundimagesofthebilateralcommoncarotidarteriesfrom112casesofT2DMpatientsand50casesofnormalsubjectsinourhospitalwerecollectedtomeasureintima-mediathicknessmeans(IMTm),end-systolicinnerdiameter(Ds),end-diastolicinnerdiameter(Dd),resistanceindex(RI),pulseindex(PI),andthesystole/diastoleratio(S/D).Wealsoobservedthevariationoftheintima-mediathickness(IMT)aswellastheelasticityindexesofthecommoncarotidartery,suchasthecompliancecoefficient(CC),elasticitycoefficient(β),pulsewavevelocity(PWV)andaugmentationindex(AIx)throughinstrumentswithbuilt-inultrasoundradio-frequencytechniques,includingquantitativeintima-mediathickness(QIMT)andquantitativeanalysisofarterialstiffness(QAS).Thedifferencesoftheabove-mentionedparametersbetweenthetwogroupswereanalyzed.ResultsTherewerenostatisticallysignificantdifferencesinIMTm,Ds,Dd,RI,PIandS/DraitoofthecommoncarotidarteriesbetweengroupT2DMandthenormalgroup(P>0.01).Theβ,PWVandAIxingroupT2DMwereremarkablyhigherthanthoseinthecontrolgroup,withCCvaluebeingsignificantlylowerthanthelater(P<0.01or0.05).ConclusionUltrasoundradio-frequencytechniqueoffersearlierandmoreeffectiveevaluationofcarotidarteryendothelialdysfunctioninT2DMpatientswhencomparedwithconventional2Dultrasound,establishingimagingfoundationfortheearlypreventionandtreatmentofcardio-cerebrovascularcomplicationsinT2DMpatients.

简介：ObjectiveTocomparetheacutehemodynamiceffectsoffivedifferentpacingmodesinpatientswithcardiacfunctionNYHAclassⅠtoⅡwithoutbundlebranchblock(BBB).MethodsThisstudyincluded12patients(SSS7,Ⅲ°AVB5)undergoingpacemakerimplantation.Rightventricularapex(RVA),rightventricularoutflowtract(RVOT),rightventricularbifocal(RV-Bi),leftventricularbase(LVB)andbi-ventricular(Bi-V)pacingat60-80ppmweredoneinVVImodepriortoimplantationofDDDpacemaker.Thecardiacindex(CI),meanpulmonaryarterypressure(mPAP)andpulmonarycapillarywedgepressure(PCWP)weremeasuredwithSwan-Ganzthermodilutioncatheterafter5minutesofeachpacingmode.Results(1)ComparingtopacingatRVA(CI:2.41±0.38L/minperm2,PCWP:16.7±3.3mmHg),theCIincreasedandthePCWPdecreasedsignificantlyinpacingatRVOT(CI:2.63±0.46,PCWP:13.8±2.3),LVB(CI:2.78±0.52,PCWP:14.4±3.1),RV-Bi(CI:2.83±0.57,PCWP:12.8±2.5)andBi-Vpacing(CI:2.

简介：BackgroundInpatientswithacutecoronarysyndrome(ACS),loweradmissionsystolicbloodpressure(SBP)levelsinferaworseprognosis.However,thepredictivepotentialofadmissionSBPon1-yearmortalityhasnotfullyelucidatedinpatientswithnon-ST-segmentelevationACS(NSTEACS).MethodsWeenrolled1325patientstoinvestigatetheassociationbetweenadmissionSBPinpatientshospitalizedforNSTEACS.WeanalyzedtheassociationbetweenadmissionSBPand1-yearmortality.AdmissionSBPwascategorizedaslow(<110mmHg),normal(110-140mmHg),high(141-160mmHg),andveryhigh(>160mmHg).ResultsComparedwithpatientswithnormaladmissionSBP,thosewithlowSBPhadasignificantlyincreasedhazardratios(HRs)for1-yearmortalityof3.03(P<0.05),whilepatientswithhighandveryhighadmissionSBPhadnosignificantlyincreasedHRsfor1-yearmortality.ConclusionLowadmissionSBP,butnotelevatedadmissionSBP,isastrongindependentpredictorof1-yearmortalityinpatientswithNSTEACS.

简介：BackgroundIntra-aorticballoonpump(IABP)hasbeenwidelyusedatpresent.Wecanuseitatdifferentstagesofperioperativeperiodinoff-pumpcoronaryarterybypassgrafting(CABG).However,whentouseditwasseldomconfirmed.MethodsFromJanuary2008toJune2012,the89coronaryheartdisease(CHD)patientsacceptedimplantationofIABPatdifferentstagesofoff-pumpCABG,preoperativeandpostoperativeventricularsystolicfunction,leftventricularremodelingsituationandthechangesofmyocardialenzymeswereevaluated.ResultsAllthepatientshadleftheartinsufficiencyandmultivesseldisease.TheirpostoperativeleftventricularsystolicfunctionandventricularremodelingweresignificantlyimprovedwhilemyocardialenzymesdecreasedwithpreoperativeinterventionalimplantationofIABP.Theperioperativemortalitywas7.86%(7/89).NopatientshadcomplicationofIABP.ConclusionEarlierIABPimplantationatpreoperationisusefultoimproveheartfunction,improvethetolerabilityofsurgery,reducetheincidenceofpostoperativelowcardiacoutputsyndrome(LCOS)anddecreasethemortality.

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简介：BackgroundNon-ST-segmentelevationacutecoronarysyndrome(NSTE-ACS)isanacuteheartdiseasecausedbyincompleteocclusionofrelatedcoronaryarterieswithunstableatheroscleroticplaques.LeadaVRSTsegmentelevationandcTnIpositivearecloselycorrelatedtotheprognosisofNSTE-ACSpatients.However,therearefewstudiesapplyingthetwopredictorstoearlyriskstratificationinNSTE-ACSpatients.MethodTwohundredandfivecasesofNSTE-ACSpatientsfollowedupfor6monthsafterdischargewerereviewed.Allpatientsweredividedintofourgroups:GroupA-cTnInegativecombinedwithaVR-non-ST-segmentelevationgroup(100cases);GroupB-cTnInegativecombinedwithaVR-ST-segmentelevationgroup(31cases);GroupC-cTnIpositivecombinedwithaVR-non-ST-segmentelevationgroup(43cases);GroupD-cTnIpositivecombinedwithaVR-ST-segmentelevationgroup(31cases).Therewasnosignificantdifferenceingender,age,oldmyocardialinfarction,previousPCIhistory,hypertension,anddiabetesbetweenaVR-STelevationgroupandnoaVR-STelevationgroup.Themorbidityofleftmainorthree-vesselcoronaryarterydiseaseaswellasadversecardiovasculareventsinthefourgroupswereobservedandanalyzed.Results(i)Themorbidityofleftmainorthree-vesselcoronaryarterydiseasewashighestinGroupD(87.1%),andwasmarkedlyhigherinGroupB(41.9%)thanthatinGroupA(7%)orGroupC(9.3%);(ii)TheincidenceofadversecardiovasculareventswashighestinGroupD(77.4%),andwasmuchhigherinB(35.5%)ascomparedwiththattinGroupA(1%)orgroupC(7%).ConclusionElectrocardiographicleadaVRST-segmentelevationcombinedwithcTnIpositivehasanimportantclinicalvalueinpredictingtheprognosisofthepatientswithNSTE-ACS.

简介：BackgroundIntheHORIZONS-AMI(HarmonizingOutcomeswithRevasculariZatiONandStentsinAcuteMyocardialInfarction)trial,3,602patientsundergoingprimarypercutaneouscoronaryintervention(PCI)forST-segmentelevationmyocardialinfarction(STEMI)treatedwithbivalirudinhadlowerbleedingandmortalityrates,buthigheracutestentthrombosisratescomparedwithheparin+aglycoproteinⅡb/Ⅲainhibitor(GPI).SubsequentchangesinprimaryPCI,includingtheuseofpotentP2Y12inhibitors,frequentradialintervention,andpre-hospitalmedicationadministration,wereincorporatedintotheEUROMAX(EuropeanAmbulanceAcuteCoronarySyndromeAngiography)trial,whichassigned2,218patientstobivalirudinversusheparin±GPIbeforeprimaryPCI.ObjectivesThegoalofthisstudywastoexaminetheoutcomesofproceduralanticoagulationwithbivalirudinversusheparin±GPIforprimaryPCI,giventheevolutioninprimaryPCI.MethodsDatabasesfromHORIZONS-AMIandEUROMAXwerepooledforpatient-levelanalysis.TheBreslow-Daytestevaluatedheterogeneitybetweentrials.ResultsAtotalof5,800patientswererandomizedtobivalirudin(n=2,889)orheparin±GPI(n=2,911).Theradialapproachwasusedin21.3%ofpatients,prasugrel/ticagrelorwasusedin18.1%ofpatients,andGPIwasusedin84.8%ofthecontrolgroup.Bivalirudincomparedwithheparin±GPIresultedinreduced30-dayratesofmajorbleeding(4.2%vs.7.8%;relativerisk[RR]:0.53;95%confidenceinterval[CI]:0.43to0.66;P<0.0001),thrombocytopenia(1.4%vs.2.9%,RR:0.48;95%CI:0.33to0.71;P=0.0002),andcardiacmortality(2.0%vs.2.9%;RR:0.70;95%CI:0.50to0.97;P=0.03),withnonsignificantlydifferentratesofreinfarction,ischemia-drivenrevascularization,stroke,andall-causemortality.Bivalirudinresultedinincreasedacute(<24h)stentthrombosisrates(1.2%vs.0.2%;RR:6.04;95%CI:2.55to14.31;P<0.0001),withnonsignificantlydifferentratesofsubacutestentthrombosis.Compositenetadversec