title: Cerebrovascular events after a primary percutaneous coronary intervention strategy for acute ST-segment-elevation myocardial infarction: analysis from the HORIZONS-AMI Trial.
abstract: BACKGROUND
  Patients with ST-segment-elevation myocardial infarction are at increased risk of cerebrovascular events. We assessed the incidence, predictors, and implications of cerebrovascular events in patients with ST-segment-elevation myocardial infarction managed with a primary percutaneous coronary intervention strategy.
  
  
  RESULTS
  In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial, 72 of 3602 patients (2.0%) experienced at least 1 cerebrovascular event (stroke: 63 patients; transient ischemic attack: 12 patients) during the 3-year follow-up (40.3% within 30 days, 20.8% between 30 days and 1 year, and 38.9% between 1 and 3 years). Stroke was ischemic in 58 (92.1%) patients and hemorrhagic in 5 (7.9%) patients. More than half of all strokes (52.3%) were disabling. By principal management strategy, cerebrovascular events developed in 2.0%, 14.9%, and 1.9% of patients triaged to primary percutaneous coronary intervention, coronary artery bypass grafting, and medical therapy, respectively (P<0.0001). Cerebrovascular events were independently predicted by older age, creatinine clearance <60 mL/min, treatment with coronary artery bypass grafting, anemia, and diabetes mellitus. Cerebrovascular events were associated with significantly increased rates of 3-year mortality (20.5% versus 6.5%; P<0.0001), as well as reinfarction (14.3% versus 3.8%; P=0.0007), ischemia-driven target vessel revascularization (22.8% versus 13.0%; P=0.006), and major bleeding (23.5% versus 8.4%; P<0.0001).
  
  
  CONCLUSIONS
  In HORIZONS-AMI, cerebrovascular events within 3 years after ST-segment-elevation myocardial infarction in patients undergoing a primary percutaneous coronary intervention management strategy occurred in 2.0% of patients and were most frequent after coronary artery bypass grafting. Cerebrovascular events were often disabling and were strongly associated with high rates of death, reinfarction, recurrent ischemia, and major bleeding.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.
authors: From the Cardiology Department, Rambam Health Care Campus and the Technion-Israel Institute of Technology, Haifa, Israel (E.N.); Cardiovascular Research Foundation, New York, NY (R.M., G.D.D., K.X., R.P., P.G., S.J.B., G.W.S.); Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.D.D.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Ospedale Papa Giovanni XXIII, Bergamo, Italy (G.G.); Rabin Medical Center, Petach-Tikva, Israel (R.K.); Hôpital du Sacré-Coeur de Montréal, Québec, Canada (P.G.); Columbia University Medical Center, New York, NY (P.G., G.W.S.); and New York Methodist Hospital, Brooklyn (S.J.B.). e_nikolsky@rambam.health.gov.il.
authors: Eugenia
authors: E
authors: Nikolsky
authors: From the Cardiology Department, Rambam Health Care Campus and the Technion-Israel Institute of Technology, Haifa, Israel (E.N.); Cardiovascular Research Foundation, New York, NY (R.M., G.D.D., K.X., R.P., P.G., S.J.B., G.W.S.); Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.D.D.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Ospedale Papa Giovanni XXIII, Bergamo, Italy (G.G.); Rabin Medical Center, Petach-Tikva, Israel (R.K.); Hôpital du Sacré-Coeur de Montréal, Québec, Canada (P.G.); Columbia University Medical Center, New York, NY (P.G., G.W.S.); and New York Methodist Hospital, Brooklyn (S.J.B.).
authors: Roxana
authors: R
authors: Mehran
authors: From the Cardiology Department, Rambam Health Care Campus and the Technion-Israel Institute of Technology, Haifa, Israel (E.N.); Cardiovascular Research Foundation, New York, NY (R.M., G.D.D., K.X., R.P., P.G., S.J.B., G.W.S.); Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.D.D.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Ospedale Papa Giovanni XXIII, Bergamo, Italy (G.G.); Rabin Medical Center, Petach-Tikva, Israel (R.K.); Hôpital du Sacré-Coeur de Montréal, Québec, Canada (P.G.); Columbia University Medical Center, New York, NY (P.G., G.W.S.); and New York Methodist Hospital, Brooklyn (S.J.B.).
authors: George D
authors: GD
authors: Dangas
authors: From the Cardiology Department, Rambam Health Care Campus and the Technion-Israel Institute of Technology, Haifa, Israel (E.N.); Cardiovascular Research Foundation, New York, NY (R.M., G.D.D., K.X., R.P., P.G., S.J.B., G.W.S.); Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.D.D.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Ospedale Papa Giovanni XXIII, Bergamo, Italy (G.G.); Rabin Medical Center, Petach-Tikva, Israel (R.K.); Hôpital du Sacré-Coeur de Montréal, Québec, Canada (P.G.); Columbia University Medical Center, New York, NY (P.G., G.W.S.); and New York Methodist Hospital, Brooklyn (S.J.B.).
authors: Ke
authors: K
authors: Xu
authors: From the Cardiology Department, Rambam Health Care Campus and the Technion-Israel Institute of Technology, Haifa, Israel (E.N.); Cardiovascular Research Foundation, New York, NY (R.M., G.D.D., K.X., R.P., P.G., S.J.B., G.W.S.); Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.D.D.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Ospedale Papa Giovanni XXIII, Bergamo, Italy (G.G.); Rabin Medical Center, Petach-Tikva, Israel (R.K.); Hôpital du Sacré-Coeur de Montréal, Québec, Canada (P.G.); Columbia University Medical Center, New York, NY (P.G., G.W.S.); and New York Methodist Hospital, Brooklyn (S.J.B.).
authors: Rupa
authors: R
authors: Parvataneni
authors: From the Cardiology Department, Rambam Health Care Campus and the Technion-Israel Institute of Technology, Haifa, Israel (E.N.); Cardiovascular Research Foundation, New York, NY (R.M., G.D.D., K.X., R.P., P.G., S.J.B., G.W.S.); Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.D.D.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Ospedale Papa Giovanni XXIII, Bergamo, Italy (G.G.); Rabin Medical Center, Petach-Tikva, Israel (R.K.); Hôpital du Sacré-Coeur de Montréal, Québec, Canada (P.G.); Columbia University Medical Center, New York, NY (P.G., G.W.S.); and New York Methodist Hospital, Brooklyn (S.J.B.).
authors: Bernhard
authors: B
authors: Witzenbichler
authors: From the Cardiology Department, Rambam Health Care Campus and the Technion-Israel Institute of Technology, Haifa, Israel (E.N.); Cardiovascular Research Foundation, New York, NY (R.M., G.D.D., K.X., R.P., P.G., S.J.B., G.W.S.); Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.D.D.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Ospedale Papa Giovanni XXIII, Bergamo, Italy (G.G.); Rabin Medical Center, Petach-Tikva, Israel (R.K.); Hôpital du Sacré-Coeur de Montréal, Québec, Canada (P.G.); Columbia University Medical Center, New York, NY (P.G., G.W.S.); and New York Methodist Hospital, Brooklyn (S.J.B.).
authors: Giulio
authors: G
authors: Guagliumi
authors: From the Cardiology Department, Rambam Health Care Campus and the Technion-Israel Institute of Technology, Haifa, Israel (E.N.); Cardiovascular Research Foundation, New York, NY (R.M., G.D.D., K.X., R.P., P.G., S.J.B., G.W.S.); Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.D.D.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Ospedale Papa Giovanni XXIII, Bergamo, Italy (G.G.); Rabin Medical Center, Petach-Tikva, Israel (R.K.); Hôpital du Sacré-Coeur de Montréal, Québec, Canada (P.G.); Columbia University Medical Center, New York, NY (P.G., G.W.S.); and New York Methodist Hospital, Brooklyn (S.J.B.).
authors: Ran
authors: R
authors: Kornowski
authors: From the Cardiology Department, Rambam Health Care Campus and the Technion-Israel Institute of Technology, Haifa, Israel (E.N.); Cardiovascular Research Foundation, New York, NY (R.M., G.D.D., K.X., R.P., P.G., S.J.B., G.W.S.); Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.D.D.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Ospedale Papa Giovanni XXIII, Bergamo, Italy (G.G.); Rabin Medical Center, Petach-Tikva, Israel (R.K.); Hôpital du Sacré-Coeur de Montréal, Québec, Canada (P.G.); Columbia University Medical Center, New York, NY (P.G., G.W.S.); and New York Methodist Hospital, Brooklyn (S.J.B.).
authors: Philippe
authors: P
authors: Généreux
authors: From the Cardiology Department, Rambam Health Care Campus and the Technion-Israel Institute of Technology, Haifa, Israel (E.N.); Cardiovascular Research Foundation, New York, NY (R.M., G.D.D., K.X., R.P., P.G., S.J.B., G.W.S.); Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.D.D.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Ospedale Papa Giovanni XXIII, Bergamo, Italy (G.G.); Rabin Medical Center, Petach-Tikva, Israel (R.K.); Hôpital du Sacré-Coeur de Montréal, Québec, Canada (P.G.); Columbia University Medical Center, New York, NY (P.G., G.W.S.); and New York Methodist Hospital, Brooklyn (S.J.B.).
authors: Sorin J
authors: SJ
authors: Brener
authors: From the Cardiology Department, Rambam Health Care Campus and the Technion-Israel Institute of Technology, Haifa, Israel (E.N.); Cardiovascular Research Foundation, New York, NY (R.M., G.D.D., K.X., R.P., P.G., S.J.B., G.W.S.); Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.D.D.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Ospedale Papa Giovanni XXIII, Bergamo, Italy (G.G.); Rabin Medical Center, Petach-Tikva, Israel (R.K.); Hôpital du Sacré-Coeur de Montréal, Québec, Canada (P.G.); Columbia University Medical Center, New York, NY (P.G., G.W.S.); and New York Methodist Hospital, Brooklyn (S.J.B.).
authors: Gregg W
authors: GW
authors: Stone
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D003404:Creatinine / Q000378:metabolism; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis
chemical_list: D003404:Creatinine
keywords: angioplasty; bivalirudin; ischemic attack, transient; myocardial infarction; stents; stroke