期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 58, 期 17, 页码 1750-1756出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2011.07.021
关键词
bivalirudin; bleeding; clinical outcomes; prognosis
资金
- Cardiovascular Research Foundation
- Boston Scientific
- Medicines Company
- Sanofi-Aventis
- Bristol-Myers Squibb
- Medtronic
- GlaxoSmithKline
- Eli Lilly-Daiichi Sankyo
- Merck
- AstraZeneca
- Abbott Vascular
- Bristol-Myers Squibb-Sanofi
- Abbott
- Adamed
- Biotronik
- Balton
- Bayer
- BBraun
- BioMatrix
- Boehringer Ingelheim
- Cordis
- Cook Eli Lilly
- EuroCor
- Glaxo
- Invatec
- MSD
- Nycomed
- Orbus-Neich
- Pfizer
- Possis
- Promed
- Siemens
- Solvay
- Terumo
- Tyco
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) (J Am Coll Cardiol 2011; 58:1750-6) (C) 2011 by the American College of Cardiology Foundation
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