http://www.theheart.org/web_slides/1136417.do A study on harmonizing outcomes with revascularization and stents in acute myocardial Infarction (HORIZONS AMI) with 3600 patients with STEMI and symptom onset of less than 12 hours undergoing primary PCI

1. 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)
GW Stone (Columbia University Medical Center Cardiovascular Research Foundation, NY)
TCT 2007 Meeting
• Population:
3600 patients with STEMI and symptom onset of less than 12 hours
undergoing primary PCI
• Treatment:
Patients randomized to UFH plus a GP IIb/IIIa inhibitor or to bivalirudin
monotherapy stopped at the end of the procedure, plus provisional GP
IIb/IIIa inhibitors for large thrombus or refractory no-flow
• Primary outcomes:
Major bleeding and net adverse clinical events* (NACE) within 30 days
UFH=unfractionated heparin
*Combination of major bleeding or major adverse CV events, including death, reinfarction, target
vessel revascularization for ischemia, and stroke

3. HORIZONS AMI: Results
• 24% reduction in NACE and 40% reduction in major bleeding at 30 days
Major outcomes at 30 days
End point UFH–GP IIb/IIIa inhibitors Bivalirudin p, noninferiority p, superiority
(%) (%)
NACE 12.1 9.2 <0.0001 0.006
Major bleeding 8.3 4.9 <0.0001 <0.0001
MACE 5.5 5.4 — NS
MACE=major adverse CV events (defined as all-cause death, reinfarction, ischemic target vessel
revascularization, or stroke)

4. HORIZONS AMI: Results
• There was a significant reduction in cardiac death at 30 days
Death at 30 days
End point UFH–GP IIb/IIIa inhibitors Bivalirudin p
(%) (%)
All death 3.1 2.1 0.058
Cardiac death 2.9 1.8 0.035

5. HORIZONS AMI: Commentary*
"It's going to be hard to find anyone who will have anything critical to say about
this. . . When there's a reduction in cardiac mortality, that kind of trumps everything
else."
- Dr Deepak Bhatt
"Overall, the results appear to look quite favorable for bivalirudin. . . . It is
reasonable to ask whether bivalirudin alone would provide superior outcomes
compared with heparin alone during contemporary management of STEMI with
primary PCI. This has important implications for clinical practice.."
- Dr Sanjay Kaul
*All comments from HORIZONS AMI: Bivalirudin reduces bleeding, adverse clinical events in STEMI
(http://www.theheart.org/article/821109.do)

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