Abstract 984: Impact of Major Adverse Cardiac Events and Major Bleeding on Overall Mortality in Patients with Acute Myocardial Infarction: Results from the HORIZONS-AMI Trial
Background. MACE and bleeding complications are strongly associated with subsequent mortality in AMI pts treated with anticoagulant and antiplatelet therapies. The relative impact of MACE and bleeding on overall mortality in AMI is not well understood.
Objectives and Methods. We sought to assess the relative impact of MACE and major bleeding events on mortality in 3,602 pts with STEMI undergoing primary PCI in the HORIZONS-AMI trial. A multivariable Cox model identified 5 significant baseline predictors of mortality within 30 days. The components of the primary composite endpoint from the trial (reinfarction, ischemic TVR, stroke and major bleeding) were added to the model as time updated covariates.
Results. Within 30 days of randomization, there were 93 deaths (2.6%); 26 following a major bleed (non CABG-related) in 238 pts, 10 following a reinfarction in 65 pts, 9 following ischemic TVR in 82 pts, and 3 following stroke in 22 pts. In the fully adjusted model, time updated reinfarction and non-CABG major bleeding were significantly associated with 30 day mortality (Figure⇓), while ischemic TVR and stroke were not. Major bleeding was strongly associated with mortality regardless of the definition (protocol defined, TIMI, or GUSTO).
Conclusion. After accounting for baseline predictors, both reinfarction and major bleeding have a significant impact on mortality in the first 30 days in this population. While the hazard ratio for reinfarction is nominally higher, there are more deaths attributable to major bleeding as compared to a reinfarction. These findings illustrate the importance of reducing both major bleeding and reinfarction in preventing deaths after primary PCI for STEMI.