1 / 7

HORIZONS-AMI: Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction

liam
Download Presentation

HORIZONS-AMI: Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Purpose To compare the safety and efficacy of heparin plus a glycoprotein IIb/IIIa inhibitor versus bivalirudin in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Reference Stone GW, Witzenbichler B, Guagliumi G, et al. for the HORIZONS-AMI Trial Investigators. Bivalirudin during Primary PCI in Acute Myocardial Infarction. N Engl J Med 2008;358:22182230. HORIZONS-AMI: Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction

    2. HORIZONS-AMI: Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction - TRIAL DESIGN - Design Prospective, open-label, randomized, multicenter trial. Patients 3602 patients aged =18 years old who had STEMI of =1 mm in two or more contiguous leads, new left bundle-branch block, or true posterior MI presenting =12 hours after symptom onset. Exclusion criteria included contraindications for or previous administration of the study medications, and any comorbidity that might limit life expectancy to <1 year or interfere with compliance with the protocol. Follow-up and primary endpoints Two primary 30-day endpoints: major bleeding unrelated to CABG; and the combination of major bleeding or a composite of major adverse cardiovascular events (death, reinfarction, target-vessel revascularization for ischemia, and stroke).

    3. HORIZONS-AMI: Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction - TRIAL DESIGN continued - Treatment Bivalirudin: 0.75 mg/kg/h bolus followed by 1.75 mg/kg/h infusion. Heparin: 60 IU/kg body weight bolus, with subsequent boluses targeted to achieve an activated clotting time of 200250 seconds. Glycoprotein IIb/IIIa inhibitor: abciximab, at 0.25 mg/kg bolus, followed by 0.125 g/kg/min infusion up to a maximum of 10 g/min; or double-bolus epifibatide, at 180 g/kg bolus followed by 2.0 g/kg/min infusion, with the second bolus given 10 minutes after the first, and no maximum dose pre-specified.

    4. HORIZONS-AMI: Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction - TRIAL DESIGN continued -

    5. Compared with heparin plus a glycoprotein IIa/IIIa inhibitor, bivalirudin led, at 30 days, to a significantly reduced rate of the following: Net adverse clinical events (9.2% vs. 12.1%, respectively; relative risk [RR], 0.76; p=0.005)? Major bleeding (4.9% vs. 8.3%, respectively; RR, 0.60; p<0.001)? Death from cardiac causes (1.8% vs. 2.9%, respectively; RR, 0.62; p=0.03) Death from all causes (2.1% vs. 3.1%, respectively; RR, 0.66; p=0.047)? There were no significant differences in the rate of major adverse cardiovascular events (5.4% vs. 5.5%, respectively; p=0.95), death from non-cardiac causes (0.2% vs. 0.3%, respectively; p=0.75), reinfarction, target-vessel revascularization, and stroke. Although rates of stent thrombosis at 30 days were not significantly different, stent thrombosis at =24 h was significantly more common with bivalirudin, at 1.3% vs. 0.3%, respectively; p<0.001)? HORIZONS-AMI: Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction - RESULTS -

    6. HORIZONS-AMI: Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction - RESULTS continued -

    7. HORIZONS-AMI: Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction - RESULTS continued -

    8. HORIZONS-AMI: Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction - SUMMARY - In patients with STEMI undergoing primary PCI, at 30 days bivalirudin alone reduced the following in comparison with heparin plus routine use of glycoprotein IIb/IIIa inhibitor: Net adverse clinical events, owing to a significant reduction in major bleeding Rates of death from cardiac causes and from all causes An increase in stent thrombosis with bivalirudin =24 hours after PCI was partially offset by a reduction in stent thrombosis between 24 hours and 30 days. There was also no increase in the overall reinfarction rate.

More Related