title: Impact of in-hospital major bleeding on late clinical outcomes after primary percutaneous coronary intervention in acute myocardial infarction the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial.
abstract: OBJECTIVE
  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: Cardiovascular Research Foundation, New York, New York, USA.
authors: Jung-Won
authors: JW
authors: Suh
authors: Roxana
authors: R
authors: Mehran
authors: Bimmer E
authors: BE
authors: Claessen
authors: Ke
authors: K
authors: Xu
authors: Usman
authors: U
authors: Baber
authors: George
authors: G
authors: Dangas
authors: Helen
authors: H
authors: Parise
authors: Alexandra J
authors: AJ
authors: Lansky
authors: Bernhard
authors: B
authors: Witzenbichler
authors: Cindy L
authors: CL
authors: Grines
authors: Giulio
authors: G
authors: Guagliumi
authors: Ran
authors: R
authors: Kornowski
authors: Jochen
authors: J
authors: Wöhrle
authors: Dariusz
authors: D
authors: Dudek
authors: Giora
authors: G
authors: Weisz
authors: Gregg W
authors: GW
authors: Stone
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D005260:Female; D006401:Hematologic Agents / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality*; D016032:Randomized Controlled Trials as Topic
chemical_list: D006401:Hematologic Agents