PMID- 22575312
OWN - NLM
STAT- MEDLINE
DCOM- 20120809
LR  - 20220330
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 59
IP  - 20
DP  - 2012 May 15
TI  - Clinical outcomes following stent thrombosis occurring in-hospital versus 
      out-of-hospital: results from the HORIZONS-AMI (Harmonizing Outcomes with 
      Revascularization and Stents in Acute Myocardial Infarction) trial.
PG  - 1752-9
LID - 10.1016/j.jacc.2011.12.042 [doi]
AB  - OBJECTIVES: The study sought to determine whether rapid access to medical care 
      and reperfusion results in a better prognosis in patients with in-hospital 
      compared with out-of-hospital stent thrombosis (ST) in patients with ST-segment 
      elevation myocardial infarction (STEMI) in the HORIZONS-AMI (Harmonizing Outcomes 
      with Revascularization and Stents in Acute Myocardial Infarction) trial. 
      BACKGROUND: Whether the prognosis of in-hospital and out-of-hospital ST are 
      similar is uncertain, with conflicting data reported from prior studies. METHODS: 
      A total of 3,602 STEMI patients undergoing primary percutaneous coronary 
      intervention (PCI) were randomized to bivalirudin (n = 1,800) versus 
      unfractionated heparin (UFH) plus a glycoprotein IIb/IIIa inhibitor (GPI) 
      (UFH+GPI; n = 1,802). Stents were implanted in 3,202 patients, 156 (4.9%) of whom 
      developed Academic Research Consortium definite/probable ST during 3-year 
      follow-up. We investigated the 1-year clinical outcomes after ST in 54 patients 
      with in-hospital ST compared with 102 patients with out-of-hospital ST. RESULTS: 
      One year after the ST event, patients with in-hospital compared with 
      out-of-hospital ST had significantly greater mortality (27.8% vs. 10.8%, p < 
      0.01); most deaths in both groups occurred within 1 week of the ST event. 
      Patients with in-hospital ST also had higher rates of major bleeding (21.2% vs. 
      6.0%, p < 0.01), but a lower rate of myocardial infarction (56.6% vs. 77.5%, p < 
      0.01). Subgroup analysis within both in-hospital and out-of-hospital ST groups 
      indicated that subacute ST had the highest mortality. By multivariable analysis, 
      1-year mortality was significantly increased in patients with in-hospital 
      compared with out-of-hospital ST (adjusted hazard ratio: 4.62, 95% confidence 
      interval: 1.98 to 10.77, p < 0.01). Additional correlates of increased mortality 
      after an ST event included diabetes and randomization to UFH+GPI (vs. 
      bivalirudin). CONCLUSIONS: Following primary PCI for STEMI, more than one-third 
      of all ST events during 3-year follow-up occurred during the index hospital 
      phase. Mortality and major bleeding were significantly higher after in-hospital 
      ST compared with out-of-hospital ST. (Harmonizing Outcomes With Revascularization 
      and Stents in Acute Myocardial Infarction; NCT00433966).
CI  - Copyright (c) 2012 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Dangas, George D
AU  - Dangas GD
AD  - Department of Cardiology, Mount Sinai Medical Center, New York, New York 10029, 
      USA. george.dangas@mssm.edu
FAU - Claessen, Bimmer E
AU  - Claessen BE
FAU - Mehran, Roxana
AU  - Mehran R
FAU - Brener, Sorin
AU  - Brener S
FAU - Brodie, Bruce R
AU  - Brodie BR
FAU - Dudek, Dariusz
AU  - Dudek D
FAU - Witzenbichler, Bernhard
AU  - Witzenbichler B
FAU - Peruga, Jan Z
AU  - Peruga JZ
FAU - Guagliumi, Giulio
AU  - Guagliumi G
FAU - Moses, Jeffrey W
AU  - Moses JW
FAU - Lansky, Alexandra J
AU  - Lansky AJ
FAU - Xu, Ke
AU  - Xu K
FAU - Stone, Gregg W
AU  - Stone GW
LA  - eng
SI  - ClinicalTrials.gov/NCT00433966
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
CIN - J Am Coll Cardiol. 2012 May 15;59(20):1760-2. PMID: 22575313
MH  - Aged
MH  - Female
MH  - Follow-Up Studies
MH  - Hirudins
MH  - Hospital Mortality/*trends
MH  - Hospitalization/trends
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*mortality/*surgery
MH  - Myocardial Revascularization/*adverse effects/methods
MH  - Peptide Fragments/therapeutic use
MH  - Recombinant Proteins/therapeutic use
MH  - Retrospective Studies
MH  - Stents/*adverse effects
MH  - Thrombosis/etiology/*mortality
MH  - Treatment Outcome
EDAT- 2012/05/12 06:00
MHDA- 2012/08/10 06:00
CRDT- 2012/05/12 06:00
PHST- 2011/09/01 00:00 [received]
PHST- 2011/11/29 00:00 [revised]
PHST- 2011/12/06 00:00 [accepted]
PHST- 2012/05/12 06:00 [entrez]
PHST- 2012/05/12 06:00 [pubmed]
PHST- 2012/08/10 06:00 [medline]
AID - S0735-1097(12)00791-7 [pii]
AID - 10.1016/j.jacc.2011.12.042 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2012 May 15;59(20):1752-9. doi: 10.1016/j.jacc.2011.12.042.