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

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• 作者：Guido Parodi ; MD ; PhD^?/sup> ; ^{parodiguido@gmail.com} ; David Antoniucci ; MD^?/sup> ; Eugenia Nikolsky ; MD^&dagger ; ; Bernhard Witzenbichler ; MD^&Dagger ; ; Giulio Guagliumi ; MD^§ ; ; Jan Z. Peruga ; MD^?/sup> ; Thomas Stuckey ; MD^¶ ; ; Darius Dudek ; MD^# ; Ran Kornowski ; MD^?? ; Franz Hartmann ; MD^&dagger ; &dagger ; ; Alexandra J. Lansky ; MD^&dagger ; ; Roxana Mehran ; MD^&dagger ; ; Gregg W. Stone ; MD^&dagger ;
• 关键词：acute myocardial infarction ; angioplasty ; bivalirudin ; bleeding ; mortality ; risk score ; stent
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2010
• 出版时间：August 2010
• 年：2010
• 卷：3
• 期：8
• 页码：796-802
• 全文大小：441 K

文摘

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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 low-risk 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. (HORIZONS-AMI trial; )