Ticagrelor or prasugrel in patients with acute coronary syndrome in relation to glomerular filtration rate

Abstract Objectives The aim of this study was to assess the safety and efficacy of ticagrelor versus prasugrel for patients with acute coronary syndrome (ACS) according to their glomerular filtration rate (GFR). Background The outcomes of ticagrelor versus prasugrel in patients with ACS according to GFR have not been defined. Methods Patients (n=3985) with GFR available were categorized in three groups according to the tertiles of GFR. The primary endpoint was a composite of all-cause death, myocardial infarction and stroke at 1 year. Results The primary endpoint occurred significantly more often in patients with low GFR compared to high GFR as well as in patients with low GFR compared to intermediate GFR (picture 1). Patients in the lowest GFR group had significantly higher ischemic and bleeding risks than patients in the intermediate (hazard ratio [HR] 1.93 and 1.68) or high GFR groups (HR 3.52 and 2.96). In the group with low GFR, the primary endpoint occurred in 103 of 677 ticagrelor patients (15.4%) and in 72 of 652 prasugrel patients (11.2%; (HR=1.45, [1.07–1.96], p=.016, picture 2). In addition, each single component of the primary endpoint and stent thrombosis were numerically lower with prasugrel compared with ticagrelor. Occurrence of myocardial infarction was 3.7% with prasugrel compared to 6.6% with ticagrelor (p=0.019). BARC 3–5 bleeding events were similar with ticagrelor and prasugrel (8.8% versus 7.1%, p=0.278). In the intermediate and high GFR group the primary endpoint and bleeding events were similar between prasugrel and ticagrelor. Conclusions The incidence of a composite endpoint (all-cause death, myocardial infarction or stroke) occurred less frequently in patients who received prasugrel compared to patients who received ticagrelor in the low GFR population, whereas rate of bleeding events was similar. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Supported by a grant (FKZ 81X1600501) from the German Center for Cardiovascular Research and the Deutsches Herzzentrum München, Germany. Primary endpoint according to GFR Low GFR: Prasugrel versus Ticagrelor

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Prognostic usefulness of an age-adapted equation for renal function assessment in older patients with acute coronary syndrome

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872617730040 ◽

2017 ◽

Vol 7 (8) ◽

pp. 703-709 ◽

Cited By ~ 1

Author(s):

Lucía Rioboo Lestón ◽

Emad Abu-Assi ◽

Sergio Raposeiras-Roubin ◽

Rafael Cobas-Paz ◽

Berenice Caneiro-Queija ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Risk Prediction ◽

Older Patients ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Coronary Syndrome ◽

Function Assessment

Background: Renal dysfunction negatively impacts survival in acute coronary syndrome patients. The Berlin Initiative Study creatinine-based (BIScrea) equation has recently been proposed for renal function assessment in older persons. However, up to now it is unknown if the superiority of the new BIScrea equation, with respect to the most recommended chronic kidney disease epidemiology collaboration creatinine-based (CKD-EPIcrea) formula, would translate into better risk prediction of adverse events in older patients with acute coronary syndrome. Objectives: To study the impact of using estimated glomerular filtration rate calculated according to the BIScrea and CKD-EPIcrea equations on mortality in acute coronary syndrome patients aged 70 years and over. Methods: Retrospectively, between 2011 and 2016, a total of 2008 patients with acute coronary syndrome (64% men; age 79±7 years) were studied. Follow-up was 18±10 months. Measures of performance were evaluated using continuous data and stratifying patients into three estimated glomerular filtration rate subgroups: ≥60, 59.9–30 and <30 mL/min/1.73 m2. Results: The two formulas afforded independent prognostic information over follow-up. However, risk prediction was most accurate using the BIScrea formula as evaluated by Cox proportional hazards models (hazard ratio (for each 10 mL/min/1.73 m2 decrease) 1.47 vs. 1.27 with the CKD-EPI equation; P<0.001 for comparison), c-statistic values (0.69 vs. 0.65, respectively; P=0.04 for comparison) and Bayesian information criterion. Net reclassification improvement based on the estimated glomerular filtration rate categories significantly favoured BIScrea +9 (95% confidence interval 2–16%; P=0.02). Conclusions: Our findings suggest that the BIScrea formula may improve death risk prediction more than the CKD-EPIcrea formula in older patients with acute coronary syndrome.

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In-Hospital Prognostic Value of Glomerular Filtration Rate in Patients With Acute Coronary Syndrome and a Normal Creatinine Level

Revista Española de Cardiología (English Edition) ◽

10.1016/s1885-5857(08)60006-7 ◽

2007 ◽

Vol 60 (7) ◽

pp. 714-719 ◽

Cited By ~ 1

Author(s):

Rocío Carda Barrio ◽

José A. de Agustín ◽

María C. Manzano ◽

Juan C. García-Rubira ◽

Antonio Fernández-Ortiz ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Creatinine Level ◽

Prognostic Value ◽

Filtration Rate ◽

Coronary Syndrome

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Glomerular filtration rate as risk predictor of short-term hospital mortality of acute coronary syndrome

Indian Heart Journal ◽

10.1016/j.ihj.2015.10.048 ◽

2015 ◽

Vol 67 ◽

pp. S19-S20

Author(s):

Tarek Senosy ◽

Alaa Ibrahim ◽

Arindam Pande ◽

Rabin Chakrabort

Keyword(s):

Acute Coronary Syndrome ◽

Glomerular Filtration Rate ◽

Hospital Mortality ◽

Glomerular Filtration ◽

Filtration Rate ◽

Short Term ◽

Coronary Syndrome ◽

Risk Predictor

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Low-risk cutoff of 90 ml/min/1.73 m2 for the estimated glomerular filtration rate and the importance of the equation for patients with acute coronary syndrome

Clinica Chimica Acta ◽

10.1016/j.cca.2021.11.010 ◽

2021 ◽

Author(s):

Peter A Kavsak ◽

Kazem Nouri

Keyword(s):

Acute Coronary Syndrome ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Low Risk ◽

Coronary Syndrome

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Association of serum cystatin C levels with acute coronary syndrome in patients of advanced age

Journal of International Medical Research ◽

10.1177/0300060519833576 ◽

2019 ◽

Vol 47 (5) ◽

pp. 1987-1997 ◽

Cited By ~ 1

Author(s):

Qingyu Huang ◽

Wei Shen ◽

Jian Li ◽

Xinping Luo ◽

Haiming Shi ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Coronary Arteries ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Advanced Age ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Coronary Syndrome

Objective This study was performed to investigate the relationship between the serum cystatin C (Cys C) level and acute coronary syndrome (ACS) in patients of advanced age. Methods The study included 184 patients with ACS and 46 healthy control subjects. Statistical analysis was performed using SPSS version 14.0 (SPSS Inc., Chicago, IL, USA). Results The serum Cys C level was significantly higher in patients with than without ACS (1.24 ± 0.30 vs. 1.42 ± 0.46 mg/L, respectively). Patients with more stenotic coronary arteries were significantly more likely to have higher median serum Cys C and creatinine levels and a lower estimated glomerular filtration rate. The multivariate logistic regression analysis demonstrated that the serum Cys C level was independently associated with the presence of ACS and the quantity of stenotic coronary arteries after adjustment for confounding factors. Additionally, the serum Cys C level was positively correlated with age, the creatinine level, and the N-terminal pro-B-type natriuretic peptide level in all patients but was negatively correlated with the estimated glomerular filtration rate. Conclusion A high serum Cys C level was independently associated with ACS and the quantity of stenotic coronary arteries in patients of advanced age regardless of renal function.

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Glomerular Filtration Rate Estimated by the CKD-EPI Formula is a Powerful Predictor of In-Hospital Adverse Clinical Outcomes After an Acute Coronary Syndrome

Angiology ◽

10.1177/0003319711409565 ◽

2011 ◽

Vol 63 (2) ◽

pp. 119-126 ◽

Cited By ~ 10

Author(s):

Hussam F. AlFaleh ◽

Abdulkareem O. Alsuwaida ◽

Anhar Ullah ◽

Ahmad Hersi ◽

Khalid F. AlHabib ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Clinical Outcomes ◽

Filtration Rate ◽

Powerful Predictor ◽

Coronary Syndrome

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The reduction of the glomerular filtration rate and the presence of microalbuminuria at the moment of admittance reduce the prognostics of patients with an acute coronary syndrome

Critical Care ◽

10.1186/cc5407 ◽

2007 ◽

Vol 11 (Suppl 2) ◽

pp. P247

Author(s):

A Lopez Lago ◽

J Garcia Acuña ◽

S De Lange ◽

E González Babarro ◽

M Jaquet Herter ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

Coronary Syndrome ◽

The Moment

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Chronic kidney disease in acute coronary syndromes: real world data of long-term outcomes

Future Cardiology ◽

10.2217/fca-2020-0220 ◽

2021 ◽

Author(s):

Carolina Saleiro ◽

Luís Puga ◽

Diana De Campos ◽

João Lopes ◽

José P Sousa ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Acute Coronary Syndrome ◽

Glomerular Filtration Rate ◽

Kidney Disease ◽

Renal Disease ◽

Glomerular Filtration ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Coronary Syndrome ◽

Study Results

Aim: Patients with chronic kidney disease (CKD) are at increased cardiovascular risk. Methods: Patients with acute coronary syndrome were retrospectively allocated to three groups (stage 3A, stage 3B or stage 4) based on the Kidney Disease Improving Global Outcomes classification formulas: the CKD Epidemiology Collaboration (CKD-EPI; N = 401) and the modification of diet in renal disease (n = 355). The primary end point was all-cause mortality (median follow-up time, 32 months [ 15–70 ]). Results: Study results showed decreased median survival was associated with poor renal function for both the CKD-EPI (78 vs 61 vs 40 months, p = 0.014) and modification of diet in renal disease groups (68 vs 57 vs 32 months, p = 0.006). After adjustment, age (OR: 1.07; 95% CI: 1.01–1.14) and pulmonary artery systolic pressure (OR: 1.08; 95% CI: 1.03–1.14), but not estimated glomerular filtration rate, were associated with decreased survival. Conclusion: Study results suggest that poor outcomes after an acute coronary syndrome were associated with comorbidities rather than estimated glomerular filtration rate level.

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