Impact of in-hospital major bleeding on late clinical outcomes after primary percutaneous coronary intervention in acute myocardial infarction: The HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) trial

Jung Won Suh, Roxana Mehran, Bimmer E. Claessen, Ke Xu, Usman Baber, George Dangas, Helen Parise, Alexandra J. Lansky, Bernhard Witzenbichler, Cindy L. Grines, Giulio Guagliumi, Ran Kornowski, Jochen Wöhrle, Dariusz Dudek, Giora Weisz, Gregg W. Stone

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130 Scopus citations

Abstract

Objectives: We aimed to investigate the long-term prognosis of patients with in-hospital major bleeding (IHMB). Background: The effect of IHMB on the long-term prognosis of patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction is unknown. Methods: Primary PCI was performed in 3,345 (92.9%) of 3,602 patients in the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial; in-hospital protocol-defined noncoronary artery bypass graftrelated major bleeding developed in 231 (6.9%). We examined medication use at discharge, mortality, and major adverse cardiovascular events (composite of death, reinfarction, stroke, or ischemic target vessel revascularization) at 3-year follow-up in patients with and without IHMB. Results: At 3-year follow-up, patients with IHMB had higher mortality (24.6% vs. 5.4%, p < 0.0001) and major adverse cardiovascular events (40.3% vs. 20.5%, p < 0.0001). The deleterious effect of major bleeding was observed within 1 month, between 1 month and 1 year, and between 1 and 3 years. IHMB was an independent predictor of mortality (hazard ratio: 2.80; 95% confidence interval: 1.89 to 4.16, p < 0.0001) at 3-year follow up. Conclusions: Patients with IHMB after primary PCI have significantly increased 3-year rates of morbidity and mortality. Further investigation is warranted to understand the mechanisms underlying this relationship and to further improve outcomes in patients with ST-segment myocardial infarction.

Original languageEnglish
Pages (from-to)1750-1756
Number of pages7
JournalJournal of the American College of Cardiology
Volume58
Issue number17
DOIs
StatePublished - 18 Oct 2011

Keywords

  • bivalirudin
  • bleeding
  • clinical outcomes
  • prognosis

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