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. \u00a0In 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.<\/p>\n
In this analysis, the authors report the final three-year results from the trial. \u00a0At 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). \u00a0 \u00a0No significant differences were seen in stent thrombosis, ischaemia-driven target vessel revascularisation, or composite adverse events. \u00a0However, stent thrombosis was high (>4.5%) in both groups. \u00a0Overall, those receiving a paclitaxel-eluting stent had lower rates of ischaemia-driven target lesion revascularisation.<\/p>\n
Conclusions:<\/strong><\/p>\n At 3 year follow-up, a mortality benefit was seen in patients treated with bivalirudin during PPCI for STEMI. \u00a0In addition, lower rates of target lesion revascularisation were seen when a drug-eluting stent was used in preference to a bare metal sten.<\/p>\n