Impact of renal dysfunction on immediate versus staged revascularization of non-culprit lesions in patients with ST segment elevation myocardial infarction: a pre-specified subgroup analysis of the randomized MULTISTARS AMI trial.
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Rohla Miklos, Huber Kurt, Varbella Ferdinando, Linke Axel, Schwarz Bettina, Felix Stephan B, Seiffert Moritz, Kesterke Rahel, Nordbeck Peter, Witzenbichler Bernhard, Lang Irene M, Kessler Mirjam, Valina Christian, Dibra Alban, Jakob Philipp, Moccetti Marco, Vercellino Matteo, Gaede Luise, Bott-Flügel Lorenz, Stehli Julia, Candreva Alessandro, Paneni Francesco, Templin Christian, Schindler Matthias, Wischnewsky Manfred, Zanda Greca, Quadri Giorgio, Mangner Norman, Toma Aurel, Magnani Giulia, Clemmensen Peter, Lüscher Thomas F, Münzel Thomas, Schulze P Christian, Laugitz Karl-Ludwig, Rottbauer Wolfgang, Neumann Franz-Josef, Schneider Steffen, Riemer Thomas, Weidinger Franz, Achenbach Stephan, Richardt Gert, Kastrati Adnan, Ford Ian, Ruschitzka Frank, Stähli Barbara E, MULTISTARS AMI Investigators
Аннотация
METHODS: In MULTISTARS AMI, patients with STEMI and MVD were randomized to immediate or staged PCI of non-culprit lesions. In this pre-specified analysis, patients were stratified according to the presence of renal dysfunction at baseline, defined at an estimated glomerular filtration rate (eGFR) of 60 ml/min/1.73 m2. Patients with an eGFR < 30 ml/min/1.73 m2 were excluded from the trial. The primary endpoint was a composite of death, non-fatal myocardial infarction, stroke, unplanned revascularization, or hospitalization for heart failure at 1 year.
RESULTS: In MULTISTARS AMI, 108 (13%) of 832 patients had renal dysfunction. The primary endpoint occurred more frequently in patients with renal dysfunction (19.4% vs. 11.2%, unadjusted HR 1.82, 95% CI 1.13-2.94), primarily driven by higher rates of death. Among patients with renal dysfunction, the rates of the primary end point were 14.5% and 24.5% in the immediate and staged PCI groups (unadjusted HR 0.55, 95% CI 0.23-1.33). There was no interaction between renal dysfunction and the randomized treatment assignment with respect to the primary end point (adjusted HR 1.30, 95% CI 0.8-2.20, pint 0.82). The occurrence of acute renal insufficiency was statistically similar in patients with renal dysfunction who underwent immediate and staged PCI (10.9% vs. 18.9%, unadjusted HR 0.61, 95% CI 0.22-1.72, pint 0.09). Renal dysfunction at baseline emerged as a strong risk factor for the development of acute renal insufficiency (adjusted HR 5.0, 95% CI 2.30-10.70, p < 0.01).
CONCLUSIONS: Outcomes with immediate compared to staged multivessel PCI did not appear significantly altered by the presence of renal dysfunction at baseline. (Supported by Boston Scientific; MULTISTARS AMI ClinicalTrials.gov number, NCT03135275).