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

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.

[1]  G. Wells,et al.  Acute Kidney Injury after Radial or Femoral Artery Access in ST-Segment Elevation Myocardial Infarction: AKI-SAFARI. , 2021, American heart journal.

[2]  L. Azzalini,et al.  Contrast-Induced Acute Kidney Injury-Definitions, Epidemiology, and Implications. , 2020, Interventional cardiology clinics.

[3]  E. Romagnoli,et al.  Association of acute kidney injury and bleeding events with mortality after radial or femoral access in patients with acute coronary syndrome undergoing invasive management: secondary analysis of a randomized clinical trial , 2019, European heart journal.

[4]  M. Valgimigli,et al.  Radial vs femoral access for the prevention of acute kidney injury (AKI) after coronary angiography or intervention: A systematic review and meta‐analysis , 2018, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[5]  E. Bramucci,et al.  Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial , 2018, The Lancet.

[6]  Manesh R. Patel,et al.  Anticoagulant Use Among Patients With End-Stage Renal Disease Undergoing Percutaneous Coronary Intervention: An Analysis From the National Cardiovascular Data Registry , 2018, Circulation. Cardiovascular Interventions.

[7]  S. de Servi,et al.  Acute Kidney Injury After Radial or Femoral Access for Invasive Acute Coronary Syndrome Management: AKI-MATRIX. , 2017, Journal of the American College of Cardiology.

[8]  A. Pichard,et al.  Comparison of Propensity Score-Matched Analysis of Acute Kidney Injury After Percutaneous Coronary Intervention With Transradial Versus Transfemoral Approaches. , 2017, The American journal of cardiology.

[9]  J. Messenger,et al.  Longitudinal Risk of Adverse Events in Patients With Acute Kidney Injury After Percutaneous Coronary Intervention: Insights From the National Cardiovascular Data Registry , 2017, Circulation. Cardiovascular interventions.

[10]  M. Valgimigli,et al.  Acute kidney injury after percutaneous coronary intervention: Rationale of the AKI‐MATRIX (acute kidney injury‐minimizing adverse hemorrhagic events by TRansradial access site and systemic implementation of angioX) sub‐study , 2015, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[11]  P. Jüni,et al.  Bivalirudin or Unfractionated Heparin in Acute Coronary Syndromes. , 2015, The New England journal of medicine.

[12]  G. Marenzi,et al.  Acute kidney injury in patients with acute coronary syndromes , 2015, Heart.

[13]  Sunil V. Rao,et al.  Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial , 2015, The Lancet.

[14]  G. Stone,et al.  Bivalirudin vs heparin with or without tirofiban during primary percutaneous coronary intervention in acute myocardial infarction: the BRIGHT randomized clinical trial. , 2015, JAMA.

[15]  M. Valgimigli.  Design and rationale for the Minimizing Adverse haemorrhagic events by TRansradial access site and systemic Implementation of angioX program. , 2014, American heart journal.

[16]  G. Stone,et al.  Contrast-induced acute kidney injury after primary percutaneous coronary intervention: results from the HORIZONS-AMI substudy. , 2014, European heart journal.

[17]  K. Huber,et al.  Bivalirudin is superior to heparins alone with bailout GP IIb/IIIa inhibitors in patients with ST-segment elevation myocardial infarction transported emergently for primary percutaneous coronary intervention: a pre-specified analysis from the EUROMAX trial , 2014, European heart journal.

[18]  Michael E Matheny,et al.  Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. , 2014, JACC. Cardiovascular interventions.

[19]  S. Pocock,et al.  Bivalirudin started during emergency transport for primary PCI. , 2013, The New England journal of medicine.

[20]  H. Gurm,et al.  The changing definition of contrast-induced nephropathy and its clinical implications: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). , 2012, American heart journal.

[21]  S. Pocock,et al.  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. , 2009, JACC. Cardiovascular interventions.

[22]  F. Scolari,et al.  The Challenge of Diagnosing Atheroembolic Renal Disease: Clinical Features and Prognostic Factors , 2007, Circulation.

[23]  E. Topol,et al.  Bivalirudin versus heparin and glycoprotein IIb/IIIa inhibition among patients with renal impairment undergoing percutaneous coronary intervention (a subanalysis of the REPLACE-2 trial). , 2005, The American journal of cardiology.