TY - JOUR
T1 - Long-term impact of chronic kidney disease in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention
T2 - The HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial
AU - Saltzman, Adam J.
AU - Stone, Gregg W.
AU - Claessen, Bimmer E.
AU - Narula, Amar
AU - Leon-Reyes, Selene
AU - Weisz, Giora
AU - Brodie, Bruce
AU - Witzenbichler, Bernhard
AU - Guagliumi, Giulio
AU - Kornowski, Ran
AU - Dudek, Dariusz
AU - Metzger, D. Christopher
AU - Lansky, Alexandra J.
AU - Nikolsky, Eugenia
AU - Dangas, George D.
AU - Mehran, Roxana
N1 - Funding Information:
Dr. Stone is a consultant for Boston Scientific, Abbott Vascular, Medtronic, and The Medicines Co. Dr. Witzenbichler has received lecture fees (modest) from The Medicines Company and Boston Scientific. Dr. Guagliumi has received grant/research support from Boston Scientific , Medtronic Vascular , LightLab Imaging , and Labcoat ; and is a consultant for Boston Scientific, Cordis, and Volcano. Dr. Dudek has received research grants or served as consultant/advisory board member for Abbott , Adamed , AstraZeneca , Biotronik , Balton , Bayer , BBraun , BioMatrix , Boston Scientific , Boehringer Ingelheim , Bristol-Myers Squibb , Cordis , Cook , Eli Lilly , EuroCor , Glaxo , Invatec , Medtronic , The Medicines Co. , MSD , Nycomed , Orbus-Neich , Pfizer , Possis , Promed , Sanofi-Aventis , Siemens , Solvay , Terumo , and Tyco . Dr. Metzger is a consultant for Abbott, Cordis, and IDEV. Dr. Dangas is a consultant for AstraZeneca; has received research grants from BMS/Sanofi-Aventis and The Medicines Co. ; and whose spouse is on the advisory board for Abbott Vascular, Ortho McNeil, and Regado BioSciences. Dr. Mehran is on the advisory board of Abbott Vascular, Ortho McNeil, and Regado Biosciences; has received research support from BMS/Sanofi-Aventis; and whose spouse is a consultant for AstraZeneca and has received research grant support from The Medicines Co. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2011/9
Y1 - 2011/9
N2 - Objectives: This study sought to investigate the impact of chronic kidney disease (CKD) in patients undergoing percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) with different antithrombotic strategies. Background: CKD is associated with increased risk of adverse ischemic and hemorrhagic events after primary PCI for STEMI. Methods: HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial was a multicenter, international, randomized trial comparing bivalirudin monotherapy or heparin plus a glycoprotein IIb/IIIa inhibitor (GPI) during primary PCI in STEMI. CKD, defined as creatinine clearance <60 ml/min, was present at baseline in 554 of 3,397 patients (16.3%). Patients were followed for 3 years. Net adverse cardiac event (NACE) was defined as the composite of death, reinfarction, ischemia-driven target vessel revascularization (TVR), stroke or noncoronary artery bypass grafting (CABG)-related major bleeding. Results: Patients with CKD compared with patients without had higher rates of NACE (41.4% vs. 23.8%, p < 0.0001), death (18.7% vs. 4.4%, p < 0.0001), and major bleeding (19.3% vs. 6.7%, p < 0.0001). Multivariable analysis identified baseline creatinine as an independent predictor of death at 3 years (hazard ratio: 1.51, 95% confidence interval: 1.21 to 1.87, p < 0.001). Patients with CKD randomized to bivalirudin monotherapy versus heparin plus GPI had no significant difference in major bleeding (19.0% vs. 19.6%, p = 0.72) or death (19.0% vs. 18.4%, p = 0.88) at 3 years. In patients with CKD, there was no difference in the rates of TVR in bare-metal stents (BMS) versus drug-eluting stents (DES) at 3 years (14.1% vs. 15.1%, p = 0.8). Conclusions: STEMI patients with CKD have significantly higher rates of death and major bleeding compared with those without CKD. In patients with CKD, there appears to be no benefit of bivalirudin compared with heparin + GPI, or DES versus BMS during primary PCI in improving clinical outcomes.
AB - Objectives: This study sought to investigate the impact of chronic kidney disease (CKD) in patients undergoing percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) with different antithrombotic strategies. Background: CKD is associated with increased risk of adverse ischemic and hemorrhagic events after primary PCI for STEMI. Methods: HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial was a multicenter, international, randomized trial comparing bivalirudin monotherapy or heparin plus a glycoprotein IIb/IIIa inhibitor (GPI) during primary PCI in STEMI. CKD, defined as creatinine clearance <60 ml/min, was present at baseline in 554 of 3,397 patients (16.3%). Patients were followed for 3 years. Net adverse cardiac event (NACE) was defined as the composite of death, reinfarction, ischemia-driven target vessel revascularization (TVR), stroke or noncoronary artery bypass grafting (CABG)-related major bleeding. Results: Patients with CKD compared with patients without had higher rates of NACE (41.4% vs. 23.8%, p < 0.0001), death (18.7% vs. 4.4%, p < 0.0001), and major bleeding (19.3% vs. 6.7%, p < 0.0001). Multivariable analysis identified baseline creatinine as an independent predictor of death at 3 years (hazard ratio: 1.51, 95% confidence interval: 1.21 to 1.87, p < 0.001). Patients with CKD randomized to bivalirudin monotherapy versus heparin plus GPI had no significant difference in major bleeding (19.0% vs. 19.6%, p = 0.72) or death (19.0% vs. 18.4%, p = 0.88) at 3 years. In patients with CKD, there was no difference in the rates of TVR in bare-metal stents (BMS) versus drug-eluting stents (DES) at 3 years (14.1% vs. 15.1%, p = 0.8). Conclusions: STEMI patients with CKD have significantly higher rates of death and major bleeding compared with those without CKD. In patients with CKD, there appears to be no benefit of bivalirudin compared with heparin + GPI, or DES versus BMS during primary PCI in improving clinical outcomes.
KW - bivalirudin
KW - chronic kidney disease
KW - ST-segment elevation myocardial infarction
UR - http://www.scopus.com/inward/record.url?scp=80052971867&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2011.06.012
DO - 10.1016/j.jcin.2011.06.012
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C2 - 21939942
AN - SCOPUS:80052971867
VL - 4
SP - 1011
EP - 1019
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
SN - 1936-8798
IS - 9
ER -