P2Y12 inhibitors in acute coronary syndrome patients with renal dysfunction: an analysis from the RENAMI and BleeMACS projects.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
De Filippo Ovidio, D'Ascenzo Fabrizio, Raposeiras-Roubin Sergio, Abu-Assi Emad, Peyracchia Mattia, Bocchino Pier Paolo, Kinnaird Tim, Ariza-Solé Albert, Liebetrau Christoph, Manzano-Fernández Sergio, Boccuzzi Giacomo, Henriques Jose Paulo Simao, Templin Christian, Wilton Stephen B, Omedè Pierluigi, Velicki Lazar, Xanthopoulou Ioanna, Correia Luis, Cerrato Enrico, Rognoni Andrea, Fabrizio Ugo, Nuñez-Gil Iván, Iannaccone Mario, Montabone Andrea, Taha Salma, Fujii Toshiharu, Durante Alessandro, Song Xiantao, Gili Sebastiano, Magnani Giulia, Varbella Ferdinando, Kawaji Tetsuma, Blanco Pedro Flores, Garay Alberto, Quadri Giorgio, Alexopoulos Dimitrios, Caneiro Queija Berenice, Huczek Zenon, Cobas Paz Rafael, González Juanatey José Ramón, Cespón Fernández María, Nie Shao-Ping, Muñoz Pousa Isabel, Kawashiri Masa-Aki, Gallo Diego, Morbiducci Umberto, Conrotto Federico, Montefusco Antonio, Dominguez-Rodriguez Alberto, López-Cuenca Angel, Cequier Angel, Iñiguez-Romo Andrés, Usmiani Tullio, Rinaldi Mauro, De Ferrari Gaetano Maria
Аннотация
METHODS AND RESULTS: All consecutive patients from RENAMI (REgistry of New Antiplatelets in patients with Myocardial Infarction) and BLEEMACS (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome) registries were stratified according to estimated glomerular filtration rate (eGFR) lower or greater than 60 mL/min/1.73 m2. Death and myocardial infarction (MI) were the primary efficacy endpoints. Major bleedings (MBs), defined as Bleeding Academic Research Consortium bleeding types 3 to 5, constituted the safety endpoint. A total of 19 255 patients were enrolled. Mean age was 63 ± 12; 14 892 (77.3%) were males. A total of 2490 (12.9%) patients had chronic kidney disease (CKD), defined as eGFR <60 mL/min/1.73 m2. 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 [hazard ratio (HR) 0.82, 95% confidence interval (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 reinfarction 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.