Primary percutaneous coronary intervention and risk of stent thrombosis: a look beyond the HORIZON.

Primary percutaneous coronary intervention (PCI) is the preferred treatment for patients with ST-segment elevation myocardial infarction (STEMI) owing to improved vessel patency, decreased infarct size, lower rates of reinfarction, and improved survival compared with pharmacological reperfusion. However, stent thrombosis (ST) remains a major concern among STEMI patients with an excess 3to 4-fold increased risk compared with PCI in an elective setting. In the present issue of Circulation, the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial investigators provide a detailed report of the incidence, timing, and predictors of ST, specifically addressing the impact of stent type and antithrombotic regimen through 2 years.1 Definite or probable ST was common (4.4%), with little more than half of events falling into the early period ( 30 days), and the remainder being observed in the late period (up to 2 years), without apparent differences in terms of stent type and antithrombotic regimen.