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Title: | Acute kidney injury in patients with acute coronary syndrome undergoing invasive management treated with bivalirudin vs. unfractionated heparin: insights from the MATRIX trial | Authors: | Landi, Antonio Branca, Mattia Ando, Giuseppe Russo, Filippo Frigoli, Enrico Gargiulo, Giuseppe Briguori, Carlo VRANCKX, Pascal Leonardi, Sergio Gragnano, Felice Calabro, Paolo Campo, Gianluca Ambrosio, Giuseppe Santucci, Andrea Varbella, Ferdinando Zaro, Tiziana Heg, Dik Windecker, Stephan Juni, Peter Pedrazzini, Giovanni Valgimigli, Marco |
Issue Date: | 2021 | Publisher: | OXFORD UNIV PRESS | Source: | European heart journal. Acute cardiovascular care (Print), 10 (10) , p. 1170 -1179 | Abstract: | Aims Acute kidney injury (AKI) is a critical complication among patients with acute coronary syndrome (ACS) undergoing invasive management. The value of adjunctive antithrombotic strategies, such as bivalirudin or unfractionated heparin (UFH) on the risk of AKI is unclear. Methods and results Among 7213 patients enrolled in the MATRIX-Antithrombin and Treatment Duration study, 128 subjects were excluded due to incomplete information on serum creatinine (sCr) or end-stage renal disease on dialysis treatment. The primary endpoint was AKI defined as an absolute (>0.5 mg/dL) or a relative (>25%) increase in sCr. AKI occurred in 601 patients (16.9%) treated with bivalirudin and 616 patients (17.4%) treated with UFH [odds ratio (OR): 0.97; 95% confidence interval (CI): 0.85-1.09; P = 0.58]. A >25% sCr increase was observed in 597 patients (16.8%) with bivalirudin and 616 patients (17.4%) with UFH (OR: 0.96; 95% CI: 0.85-1.08; P = 0.50), whereas a >0.5 mg/dL absolute sCr increase occurred in 176 patients (5.0%) with bivalirudin vs. 189 patients (5.4%) with UFH (OR: 0.92; 95% CI: 0.75-1.14; P = 0.46). By implementing the Kidney Disease Improving Global Outcomes (KDIGO) criteria, the risk of AKI was not significantly different between bivalirudin and UFH groups (OR: 0.88; 95% CI: 0.72-1.07; P = 0.21). Subgroup analyses of the primary endpoint suggested a benefit with bivalirudin in patients randomized to femoral access. Conclusion Among ACS patients undergoing invasive management, the risk of AKI was not significantly lower with bivalirudin compared with UFH. | Notes: | Valgimigli, M (corresponding author), Ente Osped Cantonale EOC, Div Cardiol, Cardioctr Ticino Inst, Via Tesserete 48, CH-6900 Lugano, Switzerland.; Valgimigli, M (corresponding author), Univ Bern, Dept Cardiol, Bern, Switzerland. marco.valgimigli@cardiocentro.org |
Keywords: | Bivalirudin;Unfractionated heparin;Acute kidney injury;Acute coronary syndromes | Document URI: | http://hdl.handle.net/1942/36515 | ISSN: | 2048-8726 | e-ISSN: | 2048-8734 | DOI: | 10.1093/ehjacc/zuab080 | ISI #: | 000735437400010 | Rights: | The Author(s) 2021. For permissions, please email: journals.permissions@oup.com. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2023 |
Appears in Collections: | Research publications |
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