P2Y12 inhibitors in acute coronary syndrome patients with renal dysfunction: an analysis from the RENAMI and BleeMACS projects.

Abstract

AIMS:

The aim of the present study was to establish the safety and efficacy profile of prasugrel and ticagrelor in real-life acute coronary syndrome (ACS) patients with renal dysfunction.

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.

• Authors: Ovidio De Filippo, Fabrizio D'Ascenzo, Sergio Raposeiras-Roubin, Emad Abu-Assi, Mattia Peyracchia, Pier Paolo Bocchino, Tim Kinnaird, Albert Ariza-Solé, Christoph Liebetrau, Sergio Manzano-Fernández, Giacomo Boccuzzi, Jose Paulo Simao Henriques, Christian Templin, Stephen B Wilton, Pierluigi Omedè, Lazar Velicki, Ioanna Xanthopoulou, Luis Correia, Enrico Cerrato, Andrea Rognoni, Ugo Fabrizio, Iván Nuñez-Gil, Mario Iannaccone, Andrea Montabone, Salma Taha, Toshiharu Fujii, Alessandro Durante, Xiantao Song, Sebastiano Gili, Giulia Magnani, Ferdinando Varbella, Tetsuma Kawaji, Pedro Flores Blanco, Alberto Garay, Giorgio Quadri, Dimitrios Alexopoulos, Berenice Caneiro Queija, Zenon Huczek, Rafael Cobas Paz, José Ramón González Juanatey, María Cespón Fernández, Shao-Ping Nie, Isabel Muñoz Pousa, Masa-Aki Kawashiri, Diego Gallo, Umberto Morbiducci, Federico Conrotto, Antonio Montefusco, Alberto Dominguez-Rodriguez, Angel López-Cuenca, Angel Cequier, Andrés Iñiguez-Romo, Tullio Usmiani, Mauro Rinaldi, Gaetano Maria De Ferrari
• Journal: European heart journal. Cardiovascular pharmacotherapy (Eur Heart J Cardiovasc Pharmacother) Vol. 6 Issue 1 Pg. 31-42 (01 01 2020) ISSN: 2055-6845 [Electronic] England
• PMID: 31511896 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: [email protected].

Chemical References

• Platelet Aggregation Inhibitors
• Purinergic P2Y Receptor Antagonists
• Prasugrel Hydrochloride
• Ticagrelor

Topics

• Acute Coronary Syndrome (diagnosis, drug therapy, mortality)
• Aged
• Aged, 80 and over
• Female
• Glomerular Filtration Rate
• Hemorrhage (chemically induced)
• Humans
• Kidney (physiopathology)
• Male
• Middle Aged
• Myocardial Infarction (diagnosis, drug therapy, mortality)
• Platelet Aggregation Inhibitors (administration & dosage, adverse effects)
• Prasugrel Hydrochloride (administration & dosage, adverse effects)
• Purinergic P2Y Receptor Antagonists (administration & dosage, adverse effects)
• Recurrence
• Registries
• Renal Insufficiency, Chronic (diagnosis, mortality, physiopathology)
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Ticagrelor (administration & dosage, adverse effects)
• Time Factors
• Treatment Outcome