Abstract 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.

中文翻译：

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接受比伐卢定与普通肝素侵入性治疗的急性冠脉综合征患者的急性肾损伤：来自 MATRIX 试验的见解

摘要 目标急性肾损伤（AKI）是接受侵入性治疗的急性冠状动脉综合征（ACS）患者的严重并发症。辅助抗血栓策略（例如比伐卢定或普通肝素 (UFH)）对 AKI 风险的价值尚不清楚。 方法和结果在参加 MATRIX-抗凝血酶和治疗持续时间研究的 7213 名患者中，有 128 名受试者因血清肌酐 (sCr) 或透析治疗的终末期肾病信息不完整而被排除。主要终点是AKI，定义为sCr的绝对(＞0.5mg/dL)或相对(＞25％)增加。接受比伐卢定治疗的 601 名患者 (16.9%) 和接受 UFH 治疗的 616 名患者 (17.4%) 发生 AKI [比值比 (OR)：0.97；95%置信区间（CI）：0.85–1.09；P = 0.58]。在 597 名比伐卢定患者 (16.8%) 和 616 名 UFH 患者 (17.4%) 中观察到 sCr 增加 > 25%（OR：0.96；95% CI：0.85-1.08；P = 0.50），而 a > 0.5比伐卢定治疗组中有 176 名患者 (5.0%) 发生了 mg/dL 绝对 sCr 升高，而 UFH 治疗组中有 189 名患者 (5.4%) 发生了 mg/dL 绝对 sCr 升高（OR：0.92；95% CI：0.75-1.14；P = 0.46）。通过实施肾脏疾病改善全球结局 (KDIGO) 标准，比伐卢定组和 UFH 组之间 AKI 的风险没有显着差异（OR：0.88；95% CI：0.72–1.07；P = 0.21）。主要终点的亚组分析表明，比伐卢定对随机接受股动脉入路的患者有益处。 结论在接受侵入性治疗的 ACS 患者中，与 UFH 相比，比伐卢定的 AKI 风险并未显着降低。 试用注册临床试验.gov NCT01433627。