Background:ISCHEMIA-CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches—Chronic Kidney Disease) reported an initial invasive treatment strategy did not reduce the risk of death or nonfatal myocardial infarction (MI) compared with a conservative treatment strategy in patients with advanced chronic kidney disease, stable coronary disease, and moderate or severe myocardial ischemia. The cumulative frequency of different MI type after randomization and subsequent prognosis have not been reported.Methods:MI classification was based on the Third Universal Definition for MI. For procedural MI, the primary MI definition used creatine kinase-MB as the preferred biomarker, whereas the secondary MI definition used cTn (cardiac troponin); both definitions included elevated biomarker-only events with higher thresholds than nonprocedural MIs. The cumulative frequency of MI type according to treatment strategy was determined. The association of MI with subsequent all-cause death and new dialysis initiation was assessed by treating MI as a time-dependent covariate.Results:The 3-year incidence of type 1 or 2 MI with the primary MI definition was 11.2% in invasive treatment strategy and 13.6% in conservative treatment strategy (hazard ratio [HR], 0.66 [95% CI, 0.42–1.02]). Procedural MIs were more frequent in invasive treatment strategy and accounted for 9.8% and 28.3% of all MIs with the primary and secondary MI definitions, respectively. Patients had an increased risk of all-cause death after type 1 MI (adjusted HR, 4.35 [95% CI, 2.73–6.93]) and after procedural MI with the primary (adjusted HR, 2.75 [95% CI, 0.99–7.60]) and secondary MI definitions (adjusted HR, 2.91 [95% CI, 1.73–4.88]). Dialysis initiation was increased after a type 1 MI (HR, 6.45 [95% CI, 2.59–16.08]) compared with patients without an MI.Conclusions:In ISCHEMIA-CKD, the invasive treatment strategy had higher rates of procedural MIs, particularly with the secondary MI definition, and lower rates of type 1 and 2 MIs. Procedural MIs, type 1 MIs, and type 2 MIs were associated with increased risk of subsequent death. Type 1 MI increased the risk of dialysis initiation.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT01985360.

中文翻译：

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ISCHEMIA-CKD 试验中心肌梗死对心血管和肾脏的影响


背景：ISCHEMIA-CKD（药物和侵入性方法的健康有效性比较国际研究 - 慢性肾脏病）报告称，与保守治疗策略相比，初始侵入性治疗策略并未降低患者死亡或非致命性心肌梗死 (MI) 的风险患有晚期慢性肾病、稳定性冠心病以及中度或重度心肌缺血。随机分组后不同类型MI类型的累积频率及后续预后尚未见报道。方法：MI分类依据MI第三个通用定义。对于程序性 MI，主要 MI 定义使用肌酸激酶-MB 作为首选生物标志物，而次要 MI 定义使用 cTn（心肌肌钙蛋白）；这两个定义都包括升高的仅生物标志物事件，其阈值高于非手术性 MI。根据治疗策略确定 MI 类型的累积频率。通过将 MI 作为时间依赖性协变量来评估 MI 与随后的全因死亡和新的透析开始的关联。结果：在侵入性治疗中，具有主要 MI 定义的 1 型或 2 型 MI 的 3 年发病率为 11.2%策略和保守治疗策略的 13.6%（风险比 [HR]，0.66 [95% CI，0.42-1.02]）。手术性 MI 在侵入性治疗策略中更为常见，分别占所有具有主要和次要 MI 定义的 MI 的 9.8% 和 28.3%。 1 型 MI 后（调整后 HR，4.35 [95% CI，2.73-6.93]）和原发性 MI 术后（调整后 HR，2.75 [95% CI，0.99-7.60]）患者全因死亡风险增加）和次要 MI 定义（调整后的 HR，2.91 [95% CI，1.73–4.88]）。 与无 MI 的患者相比，1 型 MI 后开始透析的次数增加（HR，6.45 [95% CI，2.59–16.08]）。结论：在 ISCHEMIA-CKD 中，侵入性治疗策略的手术性 MI 发生率较高，尤其是次要 MI 定义以及 1 型和 2 型 MI 发生率较低。手术性 MI、1 型 MI 和 2 型 MI 与随后死亡风险增加相关。 1 型 MI 增加了开始透析的风险。注册：URL：https://www.clinicaltrials.gov；唯一标识符：NCT01985360。