Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction: 3-year outcomes remain positive

The Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction trial previously reported a reduction in major bleeding and net adverse clinical events in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention and treated with bivalirudin, as apposed to the use of heparin and a glycoprotein IIb/IIIa inhibitor. In addition, if eligible, patients were randomised to receive a paclitaxel-eluting or a bare-metal stent, and a reduction in target lesion revascularisation procedures was seen.

In this analysis, the authors report the final 3-year results from the trial. At 3 years, patients who received bivalirudin treatment had lower all-cause mortality (5.9% vs 7.7%; p=0.03), cardiac mortality (2.9% vs 5.1%; p=0.001), reinfarction (p=0.04) and major bleeding not related to bypass graft surgery (6.9% vs 10.5%; p=0.0001). No significant differences were seen in stent thrombosis, ischaemia-driven target vessel revascularisation or composite adverse events. However, stent thrombosis was high (>4.5%) in both groups. Overall, those receiving a paclitaxel-eluting stent had lower rates of ischaemia-driven target lesion revascularisation.