PMID- 29129254
OWN - NLM
STAT- MEDLINE
DCOM- 20171120
LR  - 20171128
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 193
DP  - 2017 Nov
TI  - Does renal function affect the efficacy or safety of a pharmacoinvasive strategy 
      in patients with ST-elevation myocardial infarction? A meta-analysis.
PG  - 46-54
LID - S0002-8703(17)30215-6 [pii]
LID - 10.1016/j.ahj.2017.07.015 [doi]
AB  - 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 m(2) vs >/=60 mL/min/1.73 m(2)). 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 m(2). Patients with eGFR<60
      mL/min/1.73 m(2) were older and had higher Thrombolysis in Myocardial Infarction 
      risk scores. Compared with patients with eGFR>/=60 mL/min/1.73 m(2), 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 m(2) (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.
CI  - Copyright (c) 2017 Elsevier Inc. All rights reserved.
FAU - Russo, Juan J
AU  - Russo JJ
AD  - Terrence Donnelly Heart Centre, Michael's Hospital, Toronto, Ontario; University 
      of Toronto, Toronto, Ontario; University of Ottawa Heart Institute, Ottawa,
      Ontario.
FAU - Goodman, Shaun G
AU  - Goodman SG
AD  - Terrence Donnelly Heart Centre, Michael's Hospital, Toronto, Ontario; University 
      of Toronto, Toronto, Ontario; Canadian Heart Research Centre, Toronto, Ontario.
FAU - Cantor, Warren J
AU  - Cantor WJ
AD  - University of Toronto, Toronto, Ontario; Southlake Regional Health Centre,
      Newmarket, Ontario.
FAU - Ko, Dennis T
AU  - Ko DT
AD  - Institute for Clinical Evaluative Sciences (ICES), Sunnybrook Research Institute 
      (SRI), Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of
      Toronto, Toronto, Ontario.
FAU - Bagai, Akshay
AU  - Bagai A
AD  - Terrence Donnelly Heart Centre, Michael's Hospital, Toronto, Ontario; University 
      of Toronto, Toronto, Ontario.
FAU - Tan, Mary K
AU  - Tan MK
AD  - Canadian Heart Research Centre, Toronto, Ontario.
FAU - Di Mario, Carlo
AU  - Di Mario C
AD  - NHLI Imperial College, London, UK, and University Hospital Careggi, Florence,
      Italy.
FAU - Halvorsen, Sigrun
AU  - Halvorsen S
AD  - Oslo University Hospital, University of Oslo, Ulleval, Norway.
FAU - Le May, Michel
AU  - Le May M
AD  - University of Ottawa Heart Institute, Ottawa, Ontario.
FAU - Fernandez-Aviles, Francisco
AU  - Fernandez-Aviles F
AD  - Hospital General Universitario Gregorio Maranon, Universidad Complutense de
      Madrid, Madrid, Spain.
FAU - Scheller, Bruno
AU  - Scheller B
AD  - Innere Medizin III, Universitat des Saarlandes, Homburg, Germany.
FAU - Armstrong, Paul W
AU  - Armstrong PW
AD  - Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta.
FAU - Borgia, Francesco
AU  - Borgia F
AD  - Federico II University, Naples, Italy.
FAU - Piscione, Federico
AU  - Piscione F
AD  - Academic Hospital SS. Giovanni e Ruggi, University of Salerno, Salerno, Italy.
FAU - Sanchez, Pedro L
AU  - Sanchez PL
AD  - Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.
FAU - Yan, Andrew T
AU  - Yan AT
AD  - Terrence Donnelly Heart Centre, Michael's Hospital, Toronto, Ontario; University 
      of Toronto, Toronto, Ontario. Electronic address: yana@smh.ca.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20170802
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Fibrinolytic Agents)
SB  - AIM
SB  - IM
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Glomerular Filtration Rate/*drug effects
MH  - Humans
MH  - Kidney/drug effects/*physiopathology
MH  - *Practice Guidelines as Topic
MH  - ST Elevation Myocardial Infarction/*drug therapy/physiopathology
EDAT- 2017/11/14 06:00
MHDA- 2017/11/29 06:00
CRDT- 2017/11/14 06:00
PHST- 2017/03/05 00:00 [received]
PHST- 2017/07/30 00:00 [accepted]
PHST- 2017/11/14 06:00 [entrez]
PHST- 2017/11/14 06:00 [pubmed]
PHST- 2017/11/29 06:00 [medline]
AID - S0002-8703(17)30215-6 [pii]
AID - 10.1016/j.ahj.2017.07.015 [doi]
PST - ppublish
SO  - Am Heart J. 2017 Nov;193:46-54. doi: 10.1016/j.ahj.2017.07.015. Epub 2017 Aug 2.