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Background

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  1. Major Adverse Events in STEMI Patients Treated with Primary Angioplasty Occur More Frequently at U.S. Compared with Non U.S. Sites: Analysis from the HORIZONS AMI TrialBruce R. Brodie, Thomas Stuckey, Bernhard Witzenbichler, Giulio Guagliumi, Jan Z. Peruga, Dariusz Dudek, Ran Kornowski, Franz Hartmann, George Dangas, S.Chiu Wong, Helen Parise, Roxana Mehran, Gregg W. Stone

  2. Background • The HORIZONS trial trial provided an opportunity to compare outcomes with primary PCI for STEMI at sites in the United States versus at sites outside the United States. This has not been previously evaluated. • Patients enrolled outside of the United States in Europe, Israel and Argentina (OUS) (n = 2,788) were compared with patients enrolled in the United States (US) (n = 814). Brodie et al ACC 2008

  3. Baseline Demographics Brodie et al ACC 2008

  4. Baseline Clinical Variables Brodie et al ACC 2008

  5. Angiographic Variables Brodie et al ACC 2008

  6. US OUS Primary Management Strategy CABG Primary PCI Deferred PCI Medical Rx 89.6% 93.7% Brodie et al ACC 2008

  7. Adjunctive Pharmacology Brodie et al ACC 2008

  8. 30 Day Outcomes: US vs OUS • Adjusted Hazard Ratios (95% CI) DEATH DEATH/MI MACE MAJOR BLEEDING NACE US Better OUS Better Brodie et al ACC 2008

  9. Conclusions • STEMI patients enrolled in the HORIZONS-AMI Trial in the US had a much higher risk profile than patients enrolled outside the US. • HORIZONS patients treated with primary PCI in the US had higher rates of death, death/MI, MACE, major bleeding and NACE compared with OUS patients. • After adjusting for differences in baseline variables, US patients had significantly higher rates of MACE, Major Bleeding and NACE compared with OUS patients. • Both US and OUS patients had lower event rates with bivalirudin compared with IIb/IIIa platelet inhibitors. There were no significant interactions between US vs OUS sites and randomization treatment. Brodie et al ACC 2008

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