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 non-coronary artery bypass graft-related 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. (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI]; NCT00433966).
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 non-coronary artery bypass graft-related 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. (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI]; NCT00433966).
Authors: Renato D Lopes; Sumeet Subherwal; Dajuanicia N Holmes; Laine Thomas; Tracy Y Wang; Sunil V Rao; Erik Magnus Ohman; Matthew T Roe; Eric D Peterson; Karen P Alexander Journal: Eur Heart J Date: 2012-03-05 Impact factor: 29.983
Authors: Sunil V Rao; David Dai; Sumeet Subherwal; William S Weintraub; Ralph S Brindis; John C Messenger; Renato D Lopes; Eric D Peterson Journal: JACC Cardiovasc Interv Date: 2012-09 Impact factor: 11.195
Authors: Wouter J Kikkert; Bimmer E Claessen; Gregg W Stone; Roxana Mehran; Bernhard Witzenbichler; Bruce R Brodie; Jochen Wöhrle; Adam Witkowski; Giulio Guagliumi; Krzysztof Zmudka; José P S Henriques; Jan G P Tijssen; Elias A Sanidas; Vasiliki Chantziara; Ke Xu; George D Dangas Journal: J Thromb Thrombolysis Date: 2013-02 Impact factor: 2.300
Authors: Dmitri V Baklanov; Lisa A Kaltenbach; Steven P Marso; Sumeet S Subherwal; Dmitriy N Feldman; Kirk N Garratt; Jeptha P Curtis; John C Messenger; Sunil V Rao Journal: J Am Coll Cardiol Date: 2012-12-19 Impact factor: 24.094