Does renal function affect the efficacy or safety of a pharmacoinvasive strategy in patients with ST-elevation myocardial infarction? A meta-analysis
The efficacy and safety of pharmacoinvasive strategy following fibrinolysis for ST-elevation myocardial infarction (STEMI) in relation to renal function have not been established. Using patient-level data from 4 randomized controlled trials, we examined the efficacy and safety of pharmacoinvasive ve...
Gespeichert in:
| Veröffentlicht in: | The American heart journal 2017-11, Vol.193, p.46-54 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 54 |
|---|---|
| container_issue | |
| container_start_page | 46 |
| container_title | The American heart journal |
| container_volume | 193 |
| creator | Russo, Juan J. Goodman, Shaun G. Cantor, Warren J. Ko, Dennis T. Bagai, Akshay Tan, Mary K. Di Mario, Carlo Halvorsen, Sigrun Le May, Michel Fernandez-Avilés, Francisco Scheller, Bruno Armstrong, Paul W. Borgia, Francesco Piscione, Federico Sanchez, Pedro L. Yan, Andrew T. |
| description | The efficacy and safety of pharmacoinvasive strategy following fibrinolysis for ST-elevation myocardial infarction (STEMI) in relation to renal function have not been established.
Using patient-level data from 4 randomized controlled trials, we examined the efficacy and safety of pharmacoinvasive versus standard treatment after fibrinolysis for STEMI. Patients were stratified based on the estimated glomerular filtration rate (eGFR) on presentation ( |
| doi_str_mv | 10.1016/j.ahj.2017.07.015 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1963471079</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0002870317302156</els_id><sourcerecordid>1965450309</sourcerecordid><originalsourceid>FETCH-LOGICAL-c381t-90cfc0d3ae08902c8383bcc9bbe2361ad782ada4dc0a868c9041f4ba84926bbc3</originalsourceid><addsrcrecordid>eNp9kU2LFDEQhoMo7uzqD_AiAS9eekzSXwkeZFnXD1jw4HoO1emKk6a7Mybpkf4h_l8zM6sHD0JBVcFTbxX1EvKCsy1nvHkzbGE3bAXj7Zbl4PUjsuFMtUXTVtVjsmGMiUK2rLwglzEOuW2EbJ6SC6G4UKKuNuTXe4-RBpxhpHaZTXJ-pmAtmkTTDila6wyYlfpAI1hMubIU6H4HYQLj3XyA6A5IYwqQ8PtK3Uz3kBzOKdKfLu3o1_sCRzzASXpavYHQu7zOzRbCaeE7ek0nTFBAPmONLj4jTyyMEZ8_5Cvy7cPt_c2n4u7Lx88313eFKSVPhWLGGtaXgEwqJowsZdkZo7oORdlw6FspoIeqNwxkI41iFbdVB7JSouk6U16R12fdffA_FoxJTy4aHEeY0S9Rc9WUVctZqzL66h908EvI956ouqpZyY4UP1Mm-BgDWr0PboKwas700TM96OyZPnqmWQ5e55mXD8pLN2H_d-KPSRl4ewYwv-LgMOho8n8N9i5kn3Tv3X_kfwPUdKmr</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1965450309</pqid></control><display><type>article</type><title>Does renal function affect the efficacy or safety of a pharmacoinvasive strategy in patients with ST-elevation myocardial infarction? A meta-analysis</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><source>ProQuest Central UK/Ireland</source><creator>Russo, Juan J. ; Goodman, Shaun G. ; Cantor, Warren J. ; Ko, Dennis T. ; Bagai, Akshay ; Tan, Mary K. ; Di Mario, Carlo ; Halvorsen, Sigrun ; Le May, Michel ; Fernandez-Avilés, Francisco ; Scheller, Bruno ; Armstrong, Paul W. ; Borgia, Francesco ; Piscione, Federico ; Sanchez, Pedro L. ; Yan, Andrew T.</creator><creatorcontrib>Russo, Juan J. ; Goodman, Shaun G. ; Cantor, Warren J. ; Ko, Dennis T. ; Bagai, Akshay ; Tan, Mary K. ; Di Mario, Carlo ; Halvorsen, Sigrun ; Le May, Michel ; Fernandez-Avilés, Francisco ; Scheller, Bruno ; Armstrong, Paul W. ; Borgia, Francesco ; Piscione, Federico ; Sanchez, Pedro L. ; Yan, Andrew T.</creatorcontrib><description>The efficacy and safety of pharmacoinvasive strategy following fibrinolysis for ST-elevation myocardial infarction (STEMI) in relation to renal function have not been established.
Using patient-level data from 4 randomized controlled trials, we examined the efficacy and safety of pharmacoinvasive versus standard treatment after fibrinolysis for STEMI. Patients were stratified based on the estimated glomerular filtration rate (eGFR) on presentation (<60 mL/min/1.73 m2 vs ≥60 mL/min/1.73 m2). The primary outcome was the composite of death or reinfarction at 30 days.
Of 2,029 patients, 457 (23%) had an eGFR<60 mL/min/1.73 m2. Patients with eGFR<60 mL/min/1.73 m2 were older and had higher Thrombolysis in Myocardial Infarction risk scores. Compared with patients with eGFR≥60 mL/min/1.73 m2, patients with renal dysfunction had higher rates of the primary outcome (5.3% vs 11.8%, respectively; P<.001). There was no significant heterogeneity in the treatment effect of pharmacoinvasive strategy on the primary outcome (P heterogeneity=.73) or the rate of death or reinfarction at 1 year (P heterogeneity=.64) in relation to eGFR. Patients with renal dysfunction had higher rates of in-hospital major bleeding compared with patients with eGFR ≥60 mL/min/1.73 m2 (7.7% vs 4.3%, respectively; P=.004); however, there was no difference in bleeding events between treatment arms in the overall cohort or in relation to eGFR (P heterogeneity=.67).
Renal impairment is associated with increased rates of adverse events in STEMI patients treated with fibrinolysis. However, the safety and efficacy of pharmacoinvasive strategy are preserved in patients with renal impairment on presentation.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2017.07.015</identifier><identifier>PMID: 29129254</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute coronary syndromes ; Angioplasty ; Bleeding ; Cardiovascular disease ; Clinical outcomes ; Clinical trials ; Effectiveness ; Electrocardiography ; Epidermal growth factor receptors ; Fibrinolysis ; Fibrinolytic Agents - therapeutic use ; Glomerular filtration rate ; Glomerular Filtration Rate - drug effects ; Heart attacks ; Hemodialysis ; Humans ; Impairment ; Intervention ; Kidney - drug effects ; Kidney - physiopathology ; Kidney diseases ; Medical imaging ; Meta-analysis ; Mortality ; Myocardial infarction ; Patients ; Pharmacology ; Practice Guidelines as Topic ; Renal function ; Safety ; ST Elevation Myocardial Infarction - drug therapy ; ST Elevation Myocardial Infarction - physiopathology ; Strategy ; Stratigraphy ; Thrombolysis</subject><ispartof>The American heart journal, 2017-11, Vol.193, p.46-54</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Nov 1, 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c381t-90cfc0d3ae08902c8383bcc9bbe2361ad782ada4dc0a868c9041f4ba84926bbc3</citedby><cites>FETCH-LOGICAL-c381t-90cfc0d3ae08902c8383bcc9bbe2361ad782ada4dc0a868c9041f4ba84926bbc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1965450309?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29129254$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Russo, Juan J.</creatorcontrib><creatorcontrib>Goodman, Shaun G.</creatorcontrib><creatorcontrib>Cantor, Warren J.</creatorcontrib><creatorcontrib>Ko, Dennis T.</creatorcontrib><creatorcontrib>Bagai, Akshay</creatorcontrib><creatorcontrib>Tan, Mary K.</creatorcontrib><creatorcontrib>Di Mario, Carlo</creatorcontrib><creatorcontrib>Halvorsen, Sigrun</creatorcontrib><creatorcontrib>Le May, Michel</creatorcontrib><creatorcontrib>Fernandez-Avilés, Francisco</creatorcontrib><creatorcontrib>Scheller, Bruno</creatorcontrib><creatorcontrib>Armstrong, Paul W.</creatorcontrib><creatorcontrib>Borgia, Francesco</creatorcontrib><creatorcontrib>Piscione, Federico</creatorcontrib><creatorcontrib>Sanchez, Pedro L.</creatorcontrib><creatorcontrib>Yan, Andrew T.</creatorcontrib><title>Does renal function affect the efficacy or safety of a pharmacoinvasive strategy in patients with ST-elevation myocardial infarction? A meta-analysis</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>The efficacy and safety of pharmacoinvasive strategy following fibrinolysis for ST-elevation myocardial infarction (STEMI) in relation to renal function have not been established.
Using patient-level data from 4 randomized controlled trials, we examined the efficacy and safety of pharmacoinvasive versus standard treatment after fibrinolysis for STEMI. Patients were stratified based on the estimated glomerular filtration rate (eGFR) on presentation (<60 mL/min/1.73 m2 vs ≥60 mL/min/1.73 m2). The primary outcome was the composite of death or reinfarction at 30 days.
Of 2,029 patients, 457 (23%) had an eGFR<60 mL/min/1.73 m2. Patients with eGFR<60 mL/min/1.73 m2 were older and had higher Thrombolysis in Myocardial Infarction risk scores. Compared with patients with eGFR≥60 mL/min/1.73 m2, patients with renal dysfunction had higher rates of the primary outcome (5.3% vs 11.8%, respectively; P<.001). There was no significant heterogeneity in the treatment effect of pharmacoinvasive strategy on the primary outcome (P heterogeneity=.73) or the rate of death or reinfarction at 1 year (P heterogeneity=.64) in relation to eGFR. Patients with renal dysfunction had higher rates of in-hospital major bleeding compared with patients with eGFR ≥60 mL/min/1.73 m2 (7.7% vs 4.3%, respectively; P=.004); however, there was no difference in bleeding events between treatment arms in the overall cohort or in relation to eGFR (P heterogeneity=.67).
Renal impairment is associated with increased rates of adverse events in STEMI patients treated with fibrinolysis. However, the safety and efficacy of pharmacoinvasive strategy are preserved in patients with renal impairment on presentation.</description><subject>Acute coronary syndromes</subject><subject>Angioplasty</subject><subject>Bleeding</subject><subject>Cardiovascular disease</subject><subject>Clinical outcomes</subject><subject>Clinical trials</subject><subject>Effectiveness</subject><subject>Electrocardiography</subject><subject>Epidermal growth factor receptors</subject><subject>Fibrinolysis</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Glomerular filtration rate</subject><subject>Glomerular Filtration Rate - drug effects</subject><subject>Heart attacks</subject><subject>Hemodialysis</subject><subject>Humans</subject><subject>Impairment</subject><subject>Intervention</subject><subject>Kidney - drug effects</subject><subject>Kidney - physiopathology</subject><subject>Kidney diseases</subject><subject>Medical imaging</subject><subject>Meta-analysis</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Patients</subject><subject>Pharmacology</subject><subject>Practice Guidelines as Topic</subject><subject>Renal function</subject><subject>Safety</subject><subject>ST Elevation Myocardial Infarction - drug therapy</subject><subject>ST Elevation Myocardial Infarction - physiopathology</subject><subject>Strategy</subject><subject>Stratigraphy</subject><subject>Thrombolysis</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kU2LFDEQhoMo7uzqD_AiAS9eekzSXwkeZFnXD1jw4HoO1emKk6a7Mybpkf4h_l8zM6sHD0JBVcFTbxX1EvKCsy1nvHkzbGE3bAXj7Zbl4PUjsuFMtUXTVtVjsmGMiUK2rLwglzEOuW2EbJ6SC6G4UKKuNuTXe4-RBpxhpHaZTXJ-pmAtmkTTDila6wyYlfpAI1hMubIU6H4HYQLj3XyA6A5IYwqQ8PtK3Uz3kBzOKdKfLu3o1_sCRzzASXpavYHQu7zOzRbCaeE7ek0nTFBAPmONLj4jTyyMEZ8_5Cvy7cPt_c2n4u7Lx88313eFKSVPhWLGGtaXgEwqJowsZdkZo7oORdlw6FspoIeqNwxkI41iFbdVB7JSouk6U16R12fdffA_FoxJTy4aHEeY0S9Rc9WUVctZqzL66h908EvI956ouqpZyY4UP1Mm-BgDWr0PboKwas700TM96OyZPnqmWQ5e55mXD8pLN2H_d-KPSRl4ewYwv-LgMOho8n8N9i5kn3Tv3X_kfwPUdKmr</recordid><startdate>201711</startdate><enddate>201711</enddate><creator>Russo, Juan J.</creator><creator>Goodman, Shaun G.</creator><creator>Cantor, Warren J.</creator><creator>Ko, Dennis T.</creator><creator>Bagai, Akshay</creator><creator>Tan, Mary K.</creator><creator>Di Mario, Carlo</creator><creator>Halvorsen, Sigrun</creator><creator>Le May, Michel</creator><creator>Fernandez-Avilés, Francisco</creator><creator>Scheller, Bruno</creator><creator>Armstrong, Paul W.</creator><creator>Borgia, Francesco</creator><creator>Piscione, Federico</creator><creator>Sanchez, Pedro L.</creator><creator>Yan, Andrew T.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>201711</creationdate><title>Does renal function affect the efficacy or safety of a pharmacoinvasive strategy in patients with ST-elevation myocardial infarction? A meta-analysis</title><author>Russo, Juan J. ; Goodman, Shaun G. ; Cantor, Warren J. ; Ko, Dennis T. ; Bagai, Akshay ; Tan, Mary K. ; Di Mario, Carlo ; Halvorsen, Sigrun ; Le May, Michel ; Fernandez-Avilés, Francisco ; Scheller, Bruno ; Armstrong, Paul W. ; Borgia, Francesco ; Piscione, Federico ; Sanchez, Pedro L. ; Yan, Andrew T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c381t-90cfc0d3ae08902c8383bcc9bbe2361ad782ada4dc0a868c9041f4ba84926bbc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acute coronary syndromes</topic><topic>Angioplasty</topic><topic>Bleeding</topic><topic>Cardiovascular disease</topic><topic>Clinical outcomes</topic><topic>Clinical trials</topic><topic>Effectiveness</topic><topic>Electrocardiography</topic><topic>Epidermal growth factor receptors</topic><topic>Fibrinolysis</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Glomerular filtration rate</topic><topic>Glomerular Filtration Rate - drug effects</topic><topic>Heart attacks</topic><topic>Hemodialysis</topic><topic>Humans</topic><topic>Impairment</topic><topic>Intervention</topic><topic>Kidney - drug effects</topic><topic>Kidney - physiopathology</topic><topic>Kidney diseases</topic><topic>Medical imaging</topic><topic>Meta-analysis</topic><topic>Mortality</topic><topic>Myocardial infarction</topic><topic>Patients</topic><topic>Pharmacology</topic><topic>Practice Guidelines as Topic</topic><topic>Renal function</topic><topic>Safety</topic><topic>ST Elevation Myocardial Infarction - drug therapy</topic><topic>ST Elevation Myocardial Infarction - physiopathology</topic><topic>Strategy</topic><topic>Stratigraphy</topic><topic>Thrombolysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Russo, Juan J.</creatorcontrib><creatorcontrib>Goodman, Shaun G.</creatorcontrib><creatorcontrib>Cantor, Warren J.</creatorcontrib><creatorcontrib>Ko, Dennis T.</creatorcontrib><creatorcontrib>Bagai, Akshay</creatorcontrib><creatorcontrib>Tan, Mary K.</creatorcontrib><creatorcontrib>Di Mario, Carlo</creatorcontrib><creatorcontrib>Halvorsen, Sigrun</creatorcontrib><creatorcontrib>Le May, Michel</creatorcontrib><creatorcontrib>Fernandez-Avilés, Francisco</creatorcontrib><creatorcontrib>Scheller, Bruno</creatorcontrib><creatorcontrib>Armstrong, Paul W.</creatorcontrib><creatorcontrib>Borgia, Francesco</creatorcontrib><creatorcontrib>Piscione, Federico</creatorcontrib><creatorcontrib>Sanchez, Pedro L.</creatorcontrib><creatorcontrib>Yan, Andrew T.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Russo, Juan J.</au><au>Goodman, Shaun G.</au><au>Cantor, Warren J.</au><au>Ko, Dennis T.</au><au>Bagai, Akshay</au><au>Tan, Mary K.</au><au>Di Mario, Carlo</au><au>Halvorsen, Sigrun</au><au>Le May, Michel</au><au>Fernandez-Avilés, Francisco</au><au>Scheller, Bruno</au><au>Armstrong, Paul W.</au><au>Borgia, Francesco</au><au>Piscione, Federico</au><au>Sanchez, Pedro L.</au><au>Yan, Andrew T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does renal function affect the efficacy or safety of a pharmacoinvasive strategy in patients with ST-elevation myocardial infarction? A meta-analysis</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2017-11</date><risdate>2017</risdate><volume>193</volume><spage>46</spage><epage>54</epage><pages>46-54</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><abstract>The efficacy and safety of pharmacoinvasive strategy following fibrinolysis for ST-elevation myocardial infarction (STEMI) in relation to renal function have not been established.
Using patient-level data from 4 randomized controlled trials, we examined the efficacy and safety of pharmacoinvasive versus standard treatment after fibrinolysis for STEMI. Patients were stratified based on the estimated glomerular filtration rate (eGFR) on presentation (<60 mL/min/1.73 m2 vs ≥60 mL/min/1.73 m2). The primary outcome was the composite of death or reinfarction at 30 days.
Of 2,029 patients, 457 (23%) had an eGFR<60 mL/min/1.73 m2. Patients with eGFR<60 mL/min/1.73 m2 were older and had higher Thrombolysis in Myocardial Infarction risk scores. Compared with patients with eGFR≥60 mL/min/1.73 m2, patients with renal dysfunction had higher rates of the primary outcome (5.3% vs 11.8%, respectively; P<.001). There was no significant heterogeneity in the treatment effect of pharmacoinvasive strategy on the primary outcome (P heterogeneity=.73) or the rate of death or reinfarction at 1 year (P heterogeneity=.64) in relation to eGFR. Patients with renal dysfunction had higher rates of in-hospital major bleeding compared with patients with eGFR ≥60 mL/min/1.73 m2 (7.7% vs 4.3%, respectively; P=.004); however, there was no difference in bleeding events between treatment arms in the overall cohort or in relation to eGFR (P heterogeneity=.67).
Renal impairment is associated with increased rates of adverse events in STEMI patients treated with fibrinolysis. However, the safety and efficacy of pharmacoinvasive strategy are preserved in patients with renal impairment on presentation.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29129254</pmid><doi>10.1016/j.ahj.2017.07.015</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-8703 |
| ispartof | The American heart journal, 2017-11, Vol.193, p.46-54 |
| issn | 0002-8703 1097-6744 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1963471079 |
| source | MEDLINE; Access via ScienceDirect (Elsevier); ProQuest Central UK/Ireland |
| subjects | Acute coronary syndromes Angioplasty Bleeding Cardiovascular disease Clinical outcomes Clinical trials Effectiveness Electrocardiography Epidermal growth factor receptors Fibrinolysis Fibrinolytic Agents - therapeutic use Glomerular filtration rate Glomerular Filtration Rate - drug effects Heart attacks Hemodialysis Humans Impairment Intervention Kidney - drug effects Kidney - physiopathology Kidney diseases Medical imaging Meta-analysis Mortality Myocardial infarction Patients Pharmacology Practice Guidelines as Topic Renal function Safety ST Elevation Myocardial Infarction - drug therapy ST Elevation Myocardial Infarction - physiopathology Strategy Stratigraphy Thrombolysis |
| title | Does renal function affect the efficacy or safety of a pharmacoinvasive strategy in patients with ST-elevation myocardial infarction? A meta-analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-28T02%3A14%3A11IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Does%20renal%20function%20affect%20the%20efficacy%20or%20safety%20of%20a%20pharmacoinvasive%20strategy%20in%20patients%20with%20ST-elevation%20myocardial%20infarction?%20A%20meta-analysis&rft.jtitle=The%20American%20heart%20journal&rft.au=Russo,%20Juan%20J.&rft.date=2017-11&rft.volume=193&rft.spage=46&rft.epage=54&rft.pages=46-54&rft.issn=0002-8703&rft.eissn=1097-6744&rft_id=info:doi/10.1016/j.ahj.2017.07.015&rft_dat=%3Cproquest_cross%3E1965450309%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1965450309&rft_id=info:pmid/29129254&rft_els_id=S0002870317302156&rfr_iscdi=true |