Platelet Inhibition, Endothelial Function, and Clinical Outcome in Patients Presenting With ST‐Segment–Elevation Myocardial Infarction Randomized to Ticagrelor Versus Prasugrel Maintenance Therapy: Long‐Term Follow‐Up of the REDUCE‐MVI Trial

Abstract Background Most of the previous studies evaluated the impact of early versus delayed invasive intervention on clinical outcomes in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) in one-year period. Purpose The aim of this study was to assess whether the immediate invasive intervention influences the occurrence of death and new myocardial infarction (MI), specifically in patients with non-ST segment MI (NSTEMI) in long-term follow-up. Methods In The Randomized Study of Immediate Versus Delayed Invasive Intervention in Patients With Non ST-segment Elevation Myocardial Infarction (RIDDLE-NSTEMI) 323 patients with NSTEMI were randomized to either immediate (median time to intervention was 1.4 hours) or delayed invasive strategy (61.0 hours). The incidence of primary outcome -death or new MI at 30 days was lower in patients assigned to the immediate (n=162) than in patients assigned to the delayed (n=161) invasive intervention group (4.3% vs. 13%, respectively; p=0.008). Long-term follow-up of 5 years was available for 96.90% of the patients. Results At 5 years, the immediate invasive intervention was associated with lower rate of death or new MI, compared with delayed invasive strategy (15.8% vs 32.9%, respectively; p=0.00). The observed benefit of the immediate intervention was mainly due to an increased early reinfarction risk with the delayed strategy (2.5% vs 9.9%, p=0.001) with similar new MI rates beyond 30 days (5.9% in the immediate and 10.7% in the delayed group, p=0.130). Five-year mortality was 12.0% in the immediate invasive intervention strategy group, and 18.1% in the delayed strategy group (p=0.135). Conclusion Immediate invasive intervention in the patients with NSTEMI significantly reduces the early risk of new MI. However, the timing of invasive intervention appears not to have significant impact on the clinical outcome beyond 30 days.

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Effect of Contrast-Induced Nephropathy on the Long-Term Outcome of Patients with Non-ST Segment Elevation Myocardial Infarction

Cardiorenal Medicine ◽

10.1159/000371900 ◽

2015 ◽

Vol 5 (2) ◽

pp. 116-124 ◽

Cited By ~ 10

Author(s):

Burak Turan ◽

Ayhan Erkol ◽

Mehmet Gül ◽

Uğur Fındıkçıoğlu ◽

İsmail Erden

Keyword(s):

Myocardial Infarction ◽

Contrast Induced Nephropathy ◽

Term Outcome ◽

Long Term Outcome ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Long Term Follow Up

Background: Contrast-induced nephropathy (CIN) has been traditionally associated with increased mortality and adverse cardiovascular events. We sought to determine whether CIN has a negative impact on the long-term outcome of patients with non-ST segment elevation myocardial infarction (NSTEMI). Methods: A total of 312 consecutive patients (mean age 59 years, 76% male) who presented with NSTEMI and had undergone an early invasive procedure were retrospectively included. CIN was defined as either a 25% or 0.5-mg/dl increase in baseline serum creatinine (Cr) 72 h after the procedure. The primary endpoint of the study was mortality in the long-term follow-up (38 months, interquartile range 30-40). The secondary endpoint consisted of mortality and myocardial infarction (MI). Results: CIN developed in 30 (9.6%) patients. Independent predictors of CIN were the contrast volume-to-Cr clearance ratio, left ventricular ejection fraction and hemoglobin concentration. The primary (20 vs. 8.5%, p = 0.042) and secondary endpoints (33.3 vs. 17%, p = 0.029) were observed more frequently in patients with CIN during long-term follow-up. The unadjusted odds ratio (OR) of CIN was 2.55 [95% confidence intervals (CI) 1.04-6.24, p = 0.040] for mortality and 2.15 (CI 1.09-4.25, p = 0.028) for mortality/MI. However, after adjustment for confounding factors, CIN was not an independent predictor of either mortality (OR 1.62, CI 0.21-12.57, p = 0.646) or mortality/MI (OR 1.12, CI 0.31-4.0, p = 0.860). Conclusion: The effect of CIN on the long-term outcome of patients with NSTEMI was substantially influenced by confounding factors. CIN was a marker, rather than a mediator, of increased cardiovascular risk, and the baseline renal function was more conclusive as a long-term prognosticator.

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