Author + information
- Gennaro Giustino1,
- Roxana Mehran2,
- Ajay Kirtane3,
- Bjorn Redfors4,
- Philippe Généreux5,
- George Dangas6,
- Sorin Brener7,
- Jayne Prats8,
- Makis Deliargyris9 and
- Gregg Stone10
- 1Icahn School of Medicine at Mount Sinai, New York, New York, United States
- 2Cardiovascular Research Foundation, Zena and Michael A. Weiner Cardiovascular Institute at Mount Sinai School of Medicine, New York, New York, United States
- 3NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States
- 4CRF, New York, New York, United States
- 5Columbia University Medical Center/Hôpital du Sacré-Coeur de Montréal, New York, New York, United States
- 6Mount Sinai Medical Center, New York, New York, United States
- 7New York Methodist Hospital, Brooklyn, New York, United States
- 8The Medicines Company, Waltham, Massachusetts, United States
- 9The Medicines Company, Parsippany, New Jersey, United States
- 10Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
After primary PCI for STEMI, the risk for recurrent ischemic and bleeding events may not be uniform over time, which may impact the risk–benefit ratio of guideline-recommended antithrombotic therapies. We investigated differences in the actuarial daily ischemic risk (ADIR) and actuarial daily bleeding risk (ADBR) within the 1st year after primary PCI for STEMI.
Ischemic and bleeding events for 3602 STEMI pts enrolled in HORIZONS-AMI were classified by time of occurrence: acute (≤24h), subacute (1d to 30d), and late (30d to 1y). Aspirin and clopidogrel were prescribed for the entire year. ADIR included cardiac death, reinfarction, and definite ST. ADBR included major and minor non-CABG TIMI bleeding. The actuarial daily risk for each event was calculated: No. events / patient-days of follow-up. Generalized estimating equations assuming a Poisson distribution were used to test the least square mean differences (LSMD) between ADIR and ADBR within each time period. As detection of bleeding can be delayed, a sensitivity analysis defining the acute phase as ≤72 hours was also performed.
ADIRs were 1.03% (37 events), 0.12% (129 events), and 0.01% (113 events), and ADBRs were 0.92% (33 events), 0.20% (213 events), and 0.002% (25 events) in the acute, subacute, and late phase, respectively (p<0.0001 across periods for both). The LSMDs between ADIR and ADBR across the 3 phases are shown in the Figure.
Following primary PCI for STEMI, ADIR and ADBR were both highest within several days of STEMI and then progressively decreased over time. While the risks for ischemia and bleeding (as defined) were roughly comparable in the first 30 days, ADIR significantly exceeded ADBR after 30 days, suggesting the potential for intensified antiplatelet therapy to improve outcomes in this phase after STEMI.
CORONARY: Acute Myocardial Infarction