Nephrology Medical News about acute coronary syndromes, chronic kidney disease, anticoagulants, bivalirudin

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Impact of chronic kidney disease on early (30-day) and late (1-year) outcomes of patients with acute coronary syndromes treated with alternative antithrombotic treatment strategies: An ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) substudy
JACC - Journal of the American College of Cardiology: Cardiovascular Interventions, 08/20/09

Mehran R et al. – In pts with acute coronary syndromes (ACS), chronic kidney disease (CKD) is associated with higher 30-day and 1-yr adverse event rates. Compared with heparin + a glycoprotein IIb/IIIa inhibitor (GPI), bivalirudin monotherapy in CKD pts results in nonstatistically different ischemic outcomes, but significantly less 30-day major bleeding.

Methods

Substudy of ACUITY trial for relationship between CKD and clinical outcomes
Comparison of safety and efficacy of bivalirudin monotherapy vs heparin + a GPI
ACUITY study: 13,819 pts with moderate- and high-risk ACS undergoing an early, invasive strategy randomized to 1 of 3 antithrombin regimens: 1) heparin + a GPI, 2) bivalirudin + a GPI, 3) or bivalirudin monotherapy
CKD (creatinine clearance <60 mL/min) in 2,469 (19.1%) of 12,939 randomized pts with baseline creatinine clearance data

Results

Worse 30-day and 1-yr clinical outcomes for pts with CKD vs normal renal function
No significant differences between bivalirudin monotherapy and heparin + a GPI in rates of 30-day composite ischemia (11.1% vs 9.4%) and net clinical adverse outcomes (16.1% vs 16.9%)
Remarkably less major bleeding (6.2% vs 9.8%) at 30 day
No significant difference in 1-yr composite ischemia (22.0% vs 18.9%) or mortality (7.1% vs. 7.3%)

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