Impact of platelet glycoprotein IIb/IIIa receptor inhibitors on renal function in patients with ST-segment elevation myocardial infarction treated with primary or rescue percutaneous coronary intervention.
OBJECTIVE
Worsening renal function in patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is associated with adverse clinical outcomes. We hypothesised that platelet glycoprotein IIb/IIIa receptor inhibitors (GPI) may decrease the rate of renal function deterioration in these patients through attenuation of platelet aggregation and the possible improvement of renal rheology and haemodynamics.


RESULTS
Based on prospectively collected data, we analysed rates of renal function deterioration in 603 consecutive patients (mean age 58+/-13 years, males 82%) with STEMI treated with primary or rescue PCI. Renal function deterioration was defined as an increase in serum creatinine level of >or=25% and/or >or=0.5 mg/dl at any time point post-PCI during index hospitalisation compared with baseline value. Outcomes were stratified by treatment with GPI. Patients treated with GPI (n=442) vs. patients who were not treated with GPI (n=161) had significantly lower rates of serum creatinine increase of >or=25% compared with baseline (22.9% vs. 31.9%, P=0.02, respectively), of serum creatinine increase >or=0.5 g/dL (4.1% vs. 8.8%, P=0.02). Treatment with GPI was associated with significantly lower mean maximal increase in serum creatinine level compared with baseline value (0.14+/-0.38 vs. 0.25+/-0.45 mg/dL, P=0.005). Rates of major bleeding did not differ significantly between the two groups (7.3% vs. 5.9%; P=0.42), while 30-day mortality was significantly lower in patients treated with GPI (2.3% vs. 7.5%; P=0.005). By multivariable analysis, treatment with GPI was an independent predictor of freedom from renal function deterioration (odds ratio 0.53; 95% confidence interval 0.33-0.86; P=0.01).


CONCLUSIONS
In this analysis, administration of GPI to patients with STEMI treated with primary PCI was associated with lower rates of worsening renal function and lower 30-day mortality.
Rambam Health Care Campus Cardiology Department, Haifa, Israel.
Azriel B
AB
Osherov
Ariel
A
Roguin
Doron
D
Aronson
Ehud
E
Grenadier
Arthur
A
Kerner
Monther
M
Boulus
Michael
M
Kapeliovich
Amad
A
Hani
Haim
H
Hammerman
Rafael
R
Beyar
Eugenia
E
Nikolsky
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D007674:Kidney Diseases / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D003404:Creatinine