Parodi G， Antoniucci D， Nikolsky E， Witzenbichler B， Guagliumi G， Peruga JZ， Stuckey T， Dudek D， Kornowski R， Hartmann F， Lansky AJ， Mehran R， Stone GW.
Division of Cardiology Careggi Hospital， Florence， Italy.
Comment in:
• JACC Cardiovasc Interv. 2010 Aug;3(8):803-5.
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 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.