Efficacy of Statin Treatment According to Baseline Renal Function in Korean Patients with Acute Myocardial Infarction Not Requiring Dialysis Undergoing Newer-Generation Drug-Eluting Stent Implantation

We investigated the 2-year efficacy of statin treatment according to baseline renal function in patients with acute myocardial infarction (AMI) not requiring dialysis undergoing newer-generation drug-eluting stent (DES) implantation. A total of 18,875 AMI patients were classified into group A (statin users, n = 16,055) and group B (statin nonusers, n = 2820). According to the baseline estimated glomerular filtration rate (eGFR; ≥90, 60–89, 30–59 and <30 mL/min/1.73 m2), these two groups were sub-classified into groups A1, A2, A3 and A4 and groups B1, B2, B3 and B4. The major adverse cardiac events (MACE), defined as all-cause death, recurrent MI (re-MI) and any repeat revascularization, were evaluated. The MACE (group A1 vs. B1, p = 0.002; group A2 vs. B2, p = 0.007; group A3 vs. B3, p < 0.001; group A4 vs. B4, p < 0.001), all-cause death (p = 0.006, p < 0.001, p < 0.001, p < 0.001, respectively) and cardiac death (p = 0.004, p < 0.001, p < 0.001, p < 0.001, respectively) rates were significantly higher in statin nonusers than those in statin users. Despite the beneficial effects of statin treatment, the MACE (group A1 vs. A2 vs. A3 vs. A4: 5.2%, 6.4%, 10.1% and 18.5%, respectively), all-cause mortality (0.9%, 1.8%, 4.6% and 12.9%, respectively) and cardiac death (0.4%, 1.0%, 2.6% and 6.8%, respectively) rates were significantly increased as eGFR decreased in group A. These results may be related to the peculiar characteristics of chronic kidney disease, including increased vascular calcification and traditional or nontraditional cardiovascular risk factors. In the era of newer-generation DESs, although statin treatment was effective in reducing mortality, this beneficial effect was diminished in accordance with the deterioration of baseline renal function.

Evidence‐to‐Practice Gap for Preventing Procedure‐Related Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention

Background Acute kidney injury (AKI) is a common complication of percutaneous coronary intervention. This risk can be minimized with reduction of contrast volume via preprocedural risk assessment. We aimed to identify quality gaps for implementing the available risk scores introduced to facilitate more judicious use of contrast volume. Methods and Results We grouped 14 702 patients who underwent percutaneous coronary intervention according to the calculated NCDR (National Cardiovascular Data Registry) AKI risk score quartiles (Q1 [lowest]–Q4 [highest]). We compared the used contrast volume by the baseline renal function and NCDR AKI risk score quartiles. Factors associated with increased contrast volume usage were determined using multivariable linear regression analysis. The overall incidence of AKI was 8.9%. The used contrast volume decreased in relation to the stages of chronic kidney disease (168 mL [SD, 73.8 mL], 161 mL [SD, 75.0 mL], 140 mL [SD, 70.0 mL], and 120 mL [SD, 73.7 mL] for no, mild, moderate, and severe chronic kidney disease, respectively; P <0.001), albeit no significant correlation was observed with the calculated NCDR AKI risk quartiles. Of the variables included in the NCDR AKI risk score, anemia (7.31 mL [1.76–12.9 mL], P =0.01), heart failure on admission (10.2 mL [6.05–14.3 mL], P <0.001), acute coronary syndrome presentation (10.3 mL [7.87–12.7 mL], P <0.001), and use of an intra‐aortic balloon pump (17.7 mL [3.9–31.5 mL], P =0.012) were associated with increased contrast volume. Conclusions The contrast volume was largely determined according to the baseline renal function, not the patients' overall AKI risk. These findings highlight the importance of comprehensive risk assessment to minimize the contrast volume used in susceptible patients.

MO974PREDICTORS OF MORTALITY IN KIDNEY TRANSPLANT PATIENTS INFECTED BY SARS-COV-2 IN SOUTH OF SPAIN

Background and Aims Covid-19 pandemic has especially affected kidney transplant (KT) recipients, who are more vulnerable than the general population due to their immunosuppressive status and added comorbidities. The objetic of this study was to determine risk factors related to infection and mortality from Covid-19 in KT. Method We included 53 KT who had PCR-confirmed COVID-19 infection between march 21st and november 24th, from a total of 2030 KT. Outcomes related to patient survival were analyzed. Results 39 (73%) patients were men, with a mean age of 56±15 years old. Median time after KT where the infection took place was 104 months (IQR: 55-160). One patient was infected 40 days after transplant. 90% were on Tacrolimus therapy and 79% on MMF. 81% of patients were hypertensive, 36% diabetic and 19% had ischemic heart disease. 65% were on ARAII treatment. Clinical presentation consisted on pneumonia (64%), fever (55%), cough (70%), dyspnoea (45%), lymphopenia (66%) and gastrointestinal symptoms (36%). 21% required intubation and admission in ICU. 8 patients were asymptomatic. 18% received Hydroxychloroquine therapy plus Azithromycin, 11% Tocilizumab, 11% Ritonavir-Lopinavir, 59% steroids, 7.7% Remdesivir and 13.5% convalescent plasma. Immunosuppression was reduced in all symptomatic patients. 10 patients (19%) died. Table 1 compares the characteristics of these patients with those who survived. Conclusion We concluded that mortality in KT is very high, more than reported in general population. Risk factors are patient age, time after KT, baseline renal function, the presence of pneumonia, as well as higher CRP levels at the time of diagnosis. More experience is needed to optimize our protocols and therapy for Covid-19 in KT.

Denosumab compared with zoledronic acid on PFS in multiple myeloma: exploratory results of an international phase 3 study

An exploratory end point from a recent trial in patients with newly diagnosed multiple myeloma showed that median progression-free survival (PFS) was increased by 10.7 months with denosumab vs zoledronic acid. We performed additional analyses to identify factors that may have contributed to the favorable PFS with denosumab. Ad hoc analyses were performed for patients intending to undergo autologous stem cell transplantation (ASCT; ASCT intent), not intending to undergo ASCT (ASCT no intent), and intent-to-treat according to age (&lt;70 or ≥70 years) and baseline renal function (≤60 mL/min or &gt;60 mL/min creatinine clearance [CrCl]). Of 1718 patients, 930 (54.1%) were in the ASCT-intent subgroup, and 788 (45.9%) were in the ASCT-no-intent subgroup. In the ASCT-intent subgroup, frontline triplet (median PFS, not estimable vs 35.7 months; hazard ratio [HR] [95% confidence interval (CI)], 0.65 [0.47-0.90]; descriptive P = .009) or bortezomib-only (median PFS, not estimable vs not estimable; HR [95% CI], 0.61 [0.39–0.95]; descriptive P = .029) induction regimens demonstrated the strongest PFS benefit favoring denosumab vs zoledronic acid. In the ASCT-no-intent subgroup, no benefit with denosumab vs zoledronic acid was observed. PFS favored denosumab vs zoledronic acid in patients with CrCl &gt;60 mL/min and in patients &lt;70 years old, but no difference was observed in patients with CrCl ≤60 mL/min or patients ≥70 years old. The PFS difference observed with denosumab is one of the notable benefits reported in newly diagnosed multiple myeloma and was most pronounced in patients intending to undergo ASCT and those who received proteasome inhibitor (PI)−based triplet regimens. This study was registered at www.clinicaltrials.gov as #NCT01345019.