Bivalirudin Efficiency to improve the Coronary flow of Obstructive Coronary Artery Patients

Abstract

Background: Bivalirudin is a direct reversible inhibitor of thrombin. The synthetic 20 amino acid peptide is an active substance. As it facilitates to improve the coronary flow after PCI, we want to observe whether the Bivalirudin can improve the coronary flow before PCI. Methodology:We prospectively recruited patients of the acute coronary syndrome (ACS) excluding ST elevation MI with single significant coronary stenosis undergoing percutaneous coronary intervention (PCI). Immediately after basal culprit vessel angiogram in an appropriate view, 0.75 mg/kg of Bivalirudin intravenous bolus was started followed by a 1.75 kg/mg/hour infusion. Before doing any balloon dilatation or any other treatment to culprit lesion, the angiogram was repeated for the same previous view of the culprit's vessel. TIMI frame count (TFC) was taken as an indicator of coronary flow. TFC of culprit vessel was noted from basal and after Bivalirudin angiogram. Bivalirudin infusion was continued throughout the PCI procedure. Results:In 50 eligible Acute Coronary Syndrome patients with the mean age of 54.4 ± 14.72 yrs were recruited in this study. The culprit lesion was in LAD 23 (46%), in LCX in 15(30%) and RCA lesion in 12(24%) of patients. 40% of patients had diabetes. The Mean TFC before Bivalirudin was 16.92 ± 6.2 vs. 11.4 ± 3.8 after Bivalirudin which was statistically significant (p=<0.0001). Conclusion:Bivalirudin decrease the TIMI frame count (TFC) in acute coronary syndrome patients, before treating the culprit vessel angioplasty. As TFC depends on the coronary flow, we conclude that Bivalirudin improves coronary flow.