In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.
Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more.

We use cookies to optimise the design of this website and make continuous improvement. By continuing your visit, you consent to the use of cookies. Learn more

Impact of Major Adverse Cardiac Events and Major Bleeding on Overall Mortality in Patients with STEMI: the HORIZONS AMI Trial.

Clinical Trial Update I

Presenter report:

Mehran, Roxana (United States of America)


To determine the impact of major bleeding and/or major adverse cardiac events, a multivariable Cox model was developed with 5 significant baseline predictor variables of mortality within 30 days of presentation with STEMI in patients enrolled in HORIZONS AMI Trial.

The main event endpoints from the trial (including the components of MACE and major bleeding) were then added to the model as time updated covariates. Within 30 days of randomization, there were 93 deaths; 26 following a major bleed (non CABG-related) in 238 patients, 10 deaths following a reinfarction in 65 patients, 9 following 82 ischemic TVRs, and 3 following 22 strokes.  In the fully adjusted models, time updated reinfarction (HR [95% CI]= 9.75 [2.72,34.91]) and non-CABG major bleeding (HR [95% CI]= 4.66 [2.84,7.63]) were significantly associated with mortality, yielding 9.0 and 20.3 attributable deaths respectively.  Ischemic TVR (HR [95% CI]= 1.11 [0.29,4.21]) and stroke (HR [95% CI]= 2.64 [0.71,9.75]) were not significantly associated with mortality within the first 30 days. 

After accounting for baseline predictors, both reinfarction and major bleeding have a significant impact on mortality in the first 30 days after presenting with STEMI.  While the hazard ratio for reinfarction is nominally higher, there are more deaths attributable to major bleeding as compared with a reinfarction within the first 30 days in this population.  As most drugs which reduce ischemia also increase bleeding, the offsetting impact of adverse ischemic and hemorrhagic events must be carefully examined in future trials.

Discussant: Califf, Robert M (United States of America






Clinical Trial Update I

Notes to editor

This congress report accompanies a presentation given at the ESC Congress 2008. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.