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

Abstract

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.

• Authors: Antonio Landi, Mattia Branca, Giuseppe Andò, Filippo Russo, Enrico Frigoli, Giuseppe Gargiulo, Carlo Briguori, Pascal Vranckx, Sergio Leonardi, Felice Gragnano, Paolo Calabrò, Gianluca Campo, Giuseppe Ambrosio, Andrea Santucci, Ferdinando Varbella, Tiziana Zaro, Dik Heg, Stephan Windecker, Peter Jüni, Giovanni Pedrazzini, Marco Valgimigli, MATRIX Investigators
• Journal: European heart journal. Acute cardiovascular care (Eur Heart J Acute Cardiovasc Care) Vol. 10 Issue 10 Pg. 1170-1179 (Dec 18 2021) ISSN: 2048-8734 [Electronic] England
• PMID: 34491323 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected].

Chemical References

• Hirudins
• Peptide Fragments
• Recombinant Proteins
• Heparin
• bivalirudin

Topics

• Acute Coronary Syndrome (complications, drug therapy)
• Acute Kidney Injury (epidemiology, etiology)
• Heparin (adverse effects)
• Hirudins
• Humans
• Peptide Fragments
• Recombinant Proteins