The generally held conception of the equilibrium between hemostasis and intravascular thrombosis is that the patients who bleed are the same patients who develop stent thrombosis and, hence, have a higher rate of mortality, particularly in the setting of an acute ST-segment elevation myocardial infarction (STEMI). However, recent findings of the HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) trial, published in this issue of the Journal (3), raise serious doubts regarding the completeness of this explanation to characterize the relation among mortality, stent thrombosis, and bleeding. The scenario of DAT cessation is actually rarely encountered in acute stent thrombosis, but is common in late stent thrombosis. The inability to elucidate the operational sequence of events or clarify the association of bleeding, stent thrombosis distant from the periprocedural bleeding, and mortality suggests that the data collected in clinical trials and registries cannot fully account for these relationships. Therefore, an unmeasured confounder must be involved, which either completely, or in combination with other factors, accounts for these connections. The possibility that patient frailty is the missing variable should be tested prospectively in future studies.