Impact of bivalirudin therapy in high-risk patients with acute myocardial infarction: 1-year results from the HORIZONS-AMI (Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction) trial

Guido Parodi, David Antoniucci, Eugenia Nikolsky, Bernhard Witzenbichler, Giulio Guagliumi, Jan Z. Peruga, Thomas Stuckey, Darius Dudek, Ran Kornowski, Franz Hartmann, Alexandra J. Lansky, Roxana Mehran, Gregg W. Stone

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives This study sought to assess the relationship between 1-year mortality and baseline patient risk in the HORIZONS-AMI (Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction) trial. Background The HORIZONS-AMI trial showed that bivalirudin compared with unfractionated heparin (UFH) plus glycoprotein IIb/IIIa inhibitors (GPI) decreased major bleeding and 30-day and 1-year mortality in patients undergoing primary percutaneous intervention for acute myocardial infarction. Methods Patients in the HORIZONS-AMI trial were classified as low, intermediate, and high risk according to the CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) risk score based on 7 clinical variables. Results Among 2,530 CADILLAC-score evaluable HORIZONS-AMI trial patients, 1,522 (60%) were classified as low risk, 531 (21%) as intermediate risk, and 477 (19%) as high risk. The mortality rates in the bivalirudin and UFH plus GPI arms, respectively, were 0.4% and 1.2% (p = 0.09) in the lowrisk group, 4.2% and 4.1% (p = 0.99) in the intermediate-risk group, and 8.4% and 15.9% (p = 0.01) in the high-risk group. Among high-risk patients, there was also a decreased rate of recurrent myocardial infarction in patients randomized to bivalirudin as compared to UFH plus GPI (3.6% vs. 7.9%, p = 0.04). Conclusions In high-risk patients undergoing primary percutaneous coronary intervention for acute myocardial infarction, bivalirudin compared with UFH plus GPI reduces 1-year mortality and recurrent myocardial infarction.

Original languageEnglish
Pages (from-to)796-802
Number of pages7
JournalJACC: Cardiovascular Interventions
Volume3
Issue number8
DOIs
StatePublished - Aug 2010
Externally publishedYes

Keywords

  • acute myocardial infarction
  • angioplasty
  • bivalirudin
  • bleeding
  • mortality
  • risk score
  • stent

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