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Am Heart J. 2017 Nov;193:46-54. doi: 10.1016/j.ahj.2017.07.015. Epub 2017 Aug 2.

Does renal function affect the efficacy or safety of a pharmacoinvasive strategy in patients with ST-elevation myocardial infarction? A meta-analysis.

Author information

1
Terrence Donnelly Heart Centre, Michael's Hospital, Toronto, Ontario; University of Toronto, Toronto, Ontario; University of Ottawa Heart Institute, Ottawa, Ontario.
2
Terrence Donnelly Heart Centre, Michael's Hospital, Toronto, Ontario; University of Toronto, Toronto, Ontario; Canadian Heart Research Centre, Toronto, Ontario.
3
University of Toronto, Toronto, Ontario; Southlake Regional Health Centre, Newmarket, Ontario.
4
Institute for Clinical Evaluative Sciences (ICES), Sunnybrook Research Institute (SRI), Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario.
5
Terrence Donnelly Heart Centre, Michael's Hospital, Toronto, Ontario; University of Toronto, Toronto, Ontario.
6
Canadian Heart Research Centre, Toronto, Ontario.
7
NHLI Imperial College, London, UK, and University Hospital Careggi, Florence, Italy.
8
Oslo University Hospital, University of Oslo, Ulleval, Norway.
9
University of Ottawa Heart Institute, Ottawa, Ontario.
10
Hospital General Universitario Gregorio Maranon, Universidad Complutense de Madrid, Madrid, Spain.
11
Innere Medizin III, Universitat des Saarlandes, Homburg, Germany.
12
Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta.
13
Federico II University, Naples, Italy.
14
Academic Hospital SS. Giovanni e Ruggi, University of Salerno, Salerno, Italy.
15
Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.
16
Terrence Donnelly Heart Centre, Michael's Hospital, Toronto, Ontario; University of Toronto, Toronto, Ontario. Electronic address: yana@smh.ca.

Abstract

BACKGROUND:

The efficacy and safety of pharmacoinvasive strategy following fibrinolysis for ST-elevation myocardial infarction (STEMI) in relation to renal function have not been established.

METHODS:

Using patient-level data from 4 randomized controlled trials, we examined the efficacy and safety of pharmacoinvasive versus standard treatment after fibrinolysis for STEMI. Patients were stratified based on the estimated glomerular filtration rate (eGFR) on presentation (<60 mL/min/1.73 m2 vs ≥60 mL/min/1.73 m2). The primary outcome was the composite of death or reinfarction at 30 days.

RESULTS:

Of 2,029 patients, 457 (23%) had an eGFR<60 mL/min/1.73 m2. Patients with eGFR<60 mL/min/1.73 m2 were older and had higher Thrombolysis in Myocardial Infarction risk scores. Compared with patients with eGFR≥60 mL/min/1.73 m2, patients with renal dysfunction had higher rates of the primary outcome (5.3% vs 11.8%, respectively; P<.001). There was no significant heterogeneity in the treatment effect of pharmacoinvasive strategy on the primary outcome (P heterogeneity=.73) or the rate of death or reinfarction at 1 year (P heterogeneity=.64) in relation to eGFR. Patients with renal dysfunction had higher rates of in-hospital major bleeding compared with patients with eGFR ≥60 mL/min/1.73 m2 (7.7% vs 4.3%, respectively; P=.004); however, there was no difference in bleeding events between treatment arms in the overall cohort or in relation to eGFR (P heterogeneity=.67).

CONCLUSIONS:

Renal impairment is associated with increased rates of adverse events in STEMI patients treated with fibrinolysis. However, the safety and efficacy of pharmacoinvasive strategy are preserved in patients with renal impairment on presentation.

PMID:
29129254
DOI:
10.1016/j.ahj.2017.07.015
[Indexed for MEDLINE]

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