AIMS To compare prolonged bivalirudin infusion vs. an intra-procedural only bivalirudin infusion administration in subjects with ST-segment elevation myocardial infarction (STEMI) regarding residual stent strut thrombosis. METHODS AND RESULTS Multivessel STEMI patients undergoing primary percutaneous coronary intervention (PPCI) and scheduled for a staged percutaneous coronary intervention (PCI) before hospital discharge were selected among those allocated to either prolonged bivalirudin or intra-procedural only bivalirudin infusion in the MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and angioX) Treatment-Duration study. Optical coherence tomography (OCT) of the infarct-related artery was performed at the end of PPCI and 4-5 days thereafter during staged intervention. The predefined endpoint was the percentage difference in the number of stent cross-sections with a thrombotic area >5% at the end of PPCI and at the time of staged PCI (ΔThCS). Between September 2013 and November 2015, 137 were randomized to either intra-procedural only bivalirudin infusion (N = 64) or prolonged bivalirudin (N = 73) at 16 European sites. Mean stent area, minimum lumen area, percentage of malapposed struts, and mean percent thrombotic area were comparable after index or staged PCI. The difference in the proportion of frames with percent thrombotic area >5% (ΔTh > 5%) were -7.7 (-22.1 to 5.1) in the intra-procedural bivalirudin infusion group and -8.8 (-23.1 to 2.6) in the prolonged infusion group (P = 0.994). Time from index to follow-up OCT imaging and the infarct vessel artery did not affect this OCT-based endpoint. CONCLUSION A strategy of prolonged bivalirudin infusion after PPCI did not reduce residual stent strut thrombosis when compared with intra-procedural only bivalirudin infusion administration (funded by The Medicines Company and Terumo; MATRIX ClinicalTrials.gov number, NCT01433627).

中文翻译：

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在进行ST段抬高型心肌梗死的患者中进行术中内支架治疗与支架后延长比伐卢定输注对残余血栓负担的比较：进行了MATRIX（通过ans动脉入路部位和AngioX进行的最小化不良出血事件）OCT研究。

目的比较ST段抬高型心肌梗死（STEMI）患者在支架残留支架血栓形成方面的长期比伐卢定输注与仅术中比伐卢定输注的比较。方法和结果从多发性STEMI患者中，选择接受长期比伐卢定或仅在术中进行比伐卢定输注的MATRIX（最小不良药物）接受原发性经皮冠状动脉介入治疗（PPCI）并计划在出院前进行分阶段经皮冠状动脉介入治疗（PCI）的患者经ans动脉入路部位和angioX）治疗持续时间的出血事件研究。在PPCI结束时及其后的4-5天进行分阶段干预期间，对梗死相关动脉进行光学相干断层扫描（OCT）。预定义的终点是在PPCI结束时和分期PCI（ΔThCS）时血栓面积大于5％的支架横截面数量的百分比差异。在2013年9月至2015年11月之间，有137例患者在欧洲16个地区被随机分配为仅术中比伐卢定输注（N = 64）或延长的比伐卢定（N = 73）输注。在分期或分期PCI后，平均支架面积，最小管腔面积，支气管不良比例和平均血栓面积百分比可比。术中比伐卢定输注组血栓面积百分比> 5％（ΔTh> 5％）的帧比例差异为-7.7（-22.1至5.1），延长输注组为-8.8（-23.1至2.6）组（P = 0.994）。从指标到随访OCT成像和梗死血管的时间不影响此基于OCT的终点。