Acute kidney injury in patients with acute coronary syndrome undergoing invasive management treated with bivalirudin vs. unfractionated heparin: insights from the MATRIX trial.

Landi, Antonio; Branca, Mattia; Andò, Giuseppe; Russo, Filippo; Frigoli, Enrico; Gargiulo, Giuseppe; Briguori, Carlo; Vranckx, Pascal; Leonardi, Sergio; Gragnano, Felice; Calabrò, Paolo; Campo, Gianluca; Ambrosio, Giuseppe; Santucci, Andrea; Varbella, Ferdinando; Zaro, Tiziana; Heg, Dik; Windecker, Stephan; Jüni, Peter; Pedrazzini, Giovanni; ... (2021). Acute kidney injury in patients with acute coronary syndrome undergoing invasive management treated with bivalirudin vs. unfractionated heparin: insights from the MATRIX trial. (In Press). European Heart Journal: Acute Cardiovascular Care Sage 10.1093/ehjacc/zuab080

[img] Text
Landi_EurHeartJAcuteCardiovascCare_2021_epub.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (850kB) | Request a copy
[img] Text
Landi_EurHeartJAcuteCardiovascCare_2021_AAM.pdf - Accepted Version
Restricted to registered users only until 8 September 2022.
Available under License Publisher holds Copyright.

Download (758kB) | Request a copy

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.

TRIAL REGISTRATION

clinicaltrials.gov NCT01433627.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Branca, Mattia; Frigoli, Enrico; Heg, Dierik Hans; Windecker, Stephan and Valgimigli, Marco

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2048-8734

Publisher:

Sage

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

16 Sep 2021 11:21

Last Modified:

23 Oct 2021 18:24

Publisher DOI:

10.1093/ehjacc/zuab080

PubMed ID:

34491323

Uncontrolled Keywords:

Acute coronary syndromes Acute kidney injury Bivalirudin Unfractionated heparin

BORIS DOI:

10.48350/159319

URI:

https://boris.unibe.ch/id/eprint/159319

Actions (login required)

Edit item Edit item
Provide Feedback