Ovidio De Filippo 1 , Fabrizio D'Ascenzo 1 , Sergio Raposeiras-Roubin 2 , Emad Abu-Assi 2 , Mattia Peyracchia 1 , Pier Paolo Bocchino 1 , Tim Kinnaird 3 , Albert Ariza-Solé 4 , Christoph Liebetrau 5 , Sergio Manzano-Fernández 6 , Giacomo Boccuzzi 7 , Jose Paulo Simao Henriques 8 , Christian Templin 9 , Stephen B Wilton 10 , Pierluigi Omedè 1 , Lazar Velicki 11 , Ioanna Xanthopoulou 12 , Luis Correia 13 , Enrico Cerrato 14 , Andrea Rognoni 15 , Ugo Fabrizio 7 , Iván Nuñez-Gil 16 , Mario Iannaccone 17 , Andrea Montabone 7 , Salma Taha 18 , Toshiharu Fujii 19 , Alessandro Durante 20 , Xiantao Song 21 , Sebastiano Gili 9 , Giulia Magnani 9 , Ferdinando Varbella 14 , Tetsuma Kawaji 22 , Pedro Flores Blanco 6 , Alberto Garay 4 , Giorgio Quadri 23 , Dimitrios Alexopoulos 12 , Berenice Caneiro Queija 2 , Zenon Huczek 24 , Rafael Cobas Paz 3 , José Ramón González Juanatey 25 , María Cespón Fernández 2 , Shao-Ping Nie 26 , Isabel Muñoz Pousa 2 , Masa-Aki Kawashiri 27 , Diego Gallo 28 , Umberto Morbiducci 28 , Federico Conrotto 1 , Antonio Montefusco 1 , Alberto Dominguez-Rodriguez 29 , Angel López-Cuenca 6 , Angel Cequier 4 , Andrés Iñiguez-Romo 2 , Tullio Usmiani 1 , Mauro Rinaldi 1 , Gaetano Maria De Ferrari 1 Show Affiliations »
Abstract
AIMS: Aim of the present study was to establish the safety and efficacy profile of prasugrel and ticagrelor in real-life acute coronary syndrome (ACS) patients with renal dysfunction. METHODS AND RESULTS: All consecutive patients from RENAMI and BLEEMACS registries were stratified according to estimated glomerular filtration rate (eGFR) lower or greater than 60mL/min/1.73m2. Death and myocardial infarction (MI) were the primary efficacy endpoints. Major bleedings (MB), defined as Bleeding Academic Research Consortium bleeding types 3 to 5, constituted the safety endpoint.19255 patients were enrolled. Mean age was 63 ± 12; 14892 (77.3%) were males. 2490 (12.9%) patients had chronic kidney disease (CKD), defined as eGFR<60mL/min/1.73m2. Mean follow-up was 13±5 months. Mortality was significantly higher in CKD patients (9.4% vs 2.6%, p < 0.0001), as well as the incidence of reinfarction (5.8% vs 2.9%, p < 0.0001) and MB (5.7% vs 3%, p < 0.0001). At Cox multivariable analysis, potent P2Y12 inhibitors significantly reduced the mortality rate (HR 0.82, 95% CI 0.54-0.96, p = 0.006) and the risk of reinfarction (HR 0.53, 95% CI 0.30-0.95, p = 0.033) in CKD patients as compared to clopidogrel. The reduction of risk of re-infarction was confirmed in patients with preserved renal function. Potent P2Y12 inhibitors did not increase the risk of MB in CKD patients (HR 1.00, 95% CI 0.59-1.68, p = 0.985). CONCLUSION: In ACS patients with CKD, prasugrel and ticagrelor are associated with lower risk of death and recurrent MI without increasing the risk of MB. © Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Aim of the present study was to establish the safety and efficacy profile of prasugrel and ticagrelor in real-life acute coronary syndrome (ACS) patients with renal dysfunction . METHODS AND RESULTS: All consecutive patients from RENAMI and BLEEMACS registries were stratified according to estimated glomerular filtration rate (eGFR) lower or greater than 60mL/min/1 .73m2. Death and myocardial infarction (MI) were the primary efficacy endpoints. Major bleedings (MB), defined as Bleeding Academic Research Consortium bleeding types 3 to 5, constituted the safety endpoint.19255 patients were enrolled. Mean age was 63 ± 12; 14892 (77.3%) were males. 2490 (12.9%) patients had chronic kidney disease (CKD ), defined as eGFR<60mL/min/1 .73m2. Mean follow-up was 13±5 months. Mortality was significantly higher in CKD patients (9.4% vs 2.6%, p < 0.0001), as well as the incidence of reinfarction (5.8% vs 2.9%, p < 0.0001) and MB (5.7% vs 3%, p < 0.0001). At Cox multivariable analysis, potent P2Y12 inhibitors significantly reduced the mortality rate (HR 0.82, 95% CI 0.54-0.96, p = 0.006) and the risk of reinfarction (HR 0.53, 95% CI 0.30-0.95, p = 0.033) in CKD patients as compared to clopidogrel . The reduction of risk of re-infarction was confirmed in patients with preserved renal function. Potent P2Y12 inhibitors did not increase the risk of MB in CKD patients (HR 1.00, 95% CI 0.59-1.68, p = 0.985). CONCLUSION: In ACS patients with CKD , prasugrel and ticagrelor are associated with lower risk of death and recurrent MI without increasing the risk of MB. © Published on behalf of the European Society of Cardiology. All rights reserved.
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Entities: Chemical
Disease
Gene
Species
Keywords:
P2Y12 inhibitors; acute coronary syndromes; acute myocardial infarction; chronic kidney disease
Year: 2019
PMID： 31511896 DOI： 10.1093/ehjcvp/pvz048
Source DB: PubMed Journal: Eur Heart J Cardiovasc Pharmacother