1. For the HORIZONS AMI Investigators
Impact of Baseline Renal Function on the Safety and Effectiveness of Bivalirudin in Patients with Acute MI Undergoing Primary Angioplasty: The HORIZONS AMI trial
Roxana Mehran, Bernhard Witzenbichler, Giulio Guagliumi, Victor Guetta, Harry Suryapranata, Kurt Huber, Jochen Wöehrle, Chris Metzger, George Dangas, Helen Parise, Gregg W. Stone
For the HORIZONS AMI Investigators

2. Background and Objectives
In HORIZONS, bivalirudin monotherapy compared to heparin + GPI resulted in reduced rates of major bleeding and NACE, with comparable composite MACE in pts undergoing primary PCI.
Whether the beneficial effects of Biv are independent of renal function, an important prognostic determinate after primary PCI, has not been reported.
We evaluated 30-day outcomes overall and by randomized antithrombin treatment according to baseline renal function.
Mehran et al ACC 2008

3. Baseline Characteristics
CrCl ≥60 mL/min
(N=2783)
CrCl <60 mL/min
(N=554)
P-value
Age (years)
57.9 [50.8, 65.5]
75.4 [70.4, 80.3]
<0.0001
Male
81.1%
55.2%
Diabetes
16.0%
19.3%
0.05
Hypertension
49.9%
69.1%
Hyperlipidemia
42.2%
46.2%
0.08
Current smoking
50.4%
24.4%
Prior MI
9.7%
15.3%
Prior PCI
9.8%
13.9%
0.004
Prior CABG
2.3%
5.6%
Mehran et al ACC 2008

4. 30-Day Outcomes by Renal Function
P< for all
*Not related to CABG
**MACE = All cause death, reinfarction, ischemic TVR or stroke
Mehran et al ACC 2008

5. 30-Day Outcomes among Renally Impaired Patients (CrCl <60 mL/min) by Treatment
*Not related to CABG
**MACE = All cause death, reinfarction, ischemic TVR or stroke
Mehran et al ACC 2008

6. 30-Day Outcomes among Pts with Normal Renal Function (CrCl ≥60 mL/min) by Treatment
*Not related to CABG
**MACE = All cause death, reinfarction, ischemic TVR or stroke
Mehran et al ACC 2008

7. Conclusions
Patients with AMI and impaired renal function (CrCl <60 mL/min) undergoing primary PCI have significantly worse 30- day ischemic and bleeding outcomes compared to patients with normal renal function.
There was no significant difference in 30-day outcomes among patients with impaired renal function treated with bivalirudin monotherapy or heparin + GPI in HORIZONS-AMI study.
Among patients with normal renal function, bivalirudin monotherapy significantly reduces major bleeding and net adverse clinical events.
Mehran et al ACC 2008