Author + information
- Received April 27, 2010
- Revision received May 20, 2010
- Accepted May 31, 2010
- Published online August 1, 2010.
- Guido Parodi, MD, PhD⁎,⁎ (, )
- David Antoniucci, MD⁎,
- Eugenia Nikolsky, MD†,
- Bernhard Witzenbichler, MD‡,
- Giulio Guagliumi, MD§,
- Jan Z. Peruga, MD∥,
- Thomas Stuckey, MD¶,
- Darius Dudek, MD#,
- Ran Kornowski, MD⁎⁎,
- Franz Hartmann, MD††,
- Alexandra J. Lansky, MD†,
- Roxana Mehran, MD† and
- Gregg W. Stone, MD†
- ↵⁎Reprint requests and correspondence:
Dr. Guido Parodi, Division of Cardiology, Careggi Hospital, Viale Pieraccini 17, Florence I-50134, Italy
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; NCT00433966)
The HORIZONS-AMI trial was sponsored by the Cardiovascular Research Foundation with unrestricted grant support from Boston Scientific Corporation and The Medicines Company. Dr. Guagliumi has received research grants from Medtronic, Boston Scientific, Abbott Vascular, Lightlab Imaging and is a consultant for Boston Scientific and Volcano. Dr. Stone is a member of the Scientific Advisement Board for Boston Scientific and Abbott Vascular and is a consultant for The Medicines Company. Dr. Witzenbichler receives lecture fees from The Medicines Company, Boston Scientific, and Abbott Vascular. Dr. Stuckey has served on the Speakers' Bureau and Advisory Board for Boston Scientific. Dr. Mehran has received consulting honoraria fees from Abiomed, Abbott Vascular, Access Closure, Accumetrics, AstraZeneca, Brocco Diagnostics, Cardiva, Cordis, Daiichi-Sankyo, Eli Lilly, Gilead, Guerbet, The Medicines Company, Regado Biosciences, St. Jude, and Therox and recieves grant support (to Columbia University) from BMS/Sanofi-Aventis. All other authors report that they have no relationships to disclose.
- Received April 27, 2010.
- Revision received May 20, 2010.
- Accepted May 31, 2010.
- American College of Cardiology Foundation