The HORIZONS-AMI trials previously reported a reduction in major bleeding and net adverse clinical events in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) and treated with bivalirudin, as apposed to the use of heparin and a glycoprotein IIb/IIIa inhibitor.  In addition, if eligible, patients were randomised to receive a paclitaxel-eluting or a bare metal stent, and a reduction in target lesion revascularisation procedures was seen.

In this analysis, the authors report the final three-year results from the trial.  At 3 years, patients who received bivalirudin therapy had lower all-cause mortality (5.9% vs 7.7%; p=0.03), cardiac mortality (2.9% vs 5.1%; p=0.001), reinfarction (p=0.04), and major bleeding not related to bypass graft surgery (6.9% vs 10.5%; p=0.0001).    No significant differences were seen in stent thrombosis, ischaemia-driven target vessel revascularisation, or composite adverse events.  However, stent thrombosis was high (>4.5%) in both groups.  Overall, those receiving a paclitaxel-eluting stent had lower rates of ischaemia-driven target lesion revascularisation.

Conclusions:

At 3 year follow-up, a mortality benefit was seen in patients treated with bivalirudin during PPCI for STEMI.  In addition, lower rates of target lesion revascularisation were seen when a drug-eluting stent was used in preference to a bare metal sten.

• Stone GW, Witzenbichler B, Guagliumi G et al. on behalf of the HORIZONS AMI Trial Investigators. Heparin plus a glycoprotein IIb/IIIa inhibitor versus bivalirudin monotherapy and paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction (HORIZONS AMI): final 3-year results from a multicentre, randomised controlled trial. Lancet 2011;377:2193-2204