Related Experiment Video
Updated: Sep 1, 2025
Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
Cardiovascular and Renal Implications of Myocardial Infarction in the ISCHEMIA-CKD Trial
Bernard R Chaitman1, Derek D Cyr2, Karen P Alexander2
1Saint Louis University School of Medicine, MO (B.R.C.).
Insights
In patients with advanced chronic kidney disease and coronary disease, an invasive strategy led to more procedural myocardial infarctions (MIs) but fewer type 1 MIs. All MI types increased death risk, and type 1 MI raised dialysis initiation risk.
Area of Science:
- Cardiology
- Nephrology
- Clinical Trials
Background:
- The ISCHEMIA-CKD study previously found no difference in death or MI risk between invasive and conservative strategies for advanced chronic kidney disease patients.
- The cumulative frequency and prognostic impact of different myocardial infarction (MI) types following these strategies were not previously reported.
Purpose of the Study:
- To determine the cumulative frequency of MI types after randomization in the ISCHEMIA-CKD trial.
- To assess the association of MI types with subsequent all-cause death and new dialysis initiation.
Main Methods:
- MI classification followed the Third Universal Definition for MI, using creatine kinase-MB or cardiac troponin (cTn) biomarkers.
- Procedural MIs were analyzed using primary and secondary definitions.
- The association of MI types with death and dialysis initiation was assessed using time-dependent covariates.
Main Results:
- The 3-year incidence of type 1 or 2 MI was lower with the invasive strategy (11.2%) versus conservative (13.6%).
- Procedural MIs were more frequent with the invasive strategy (9.8% primary, 28.3% secondary definition).
- All MI types (type 1, procedural) were associated with increased risk of death, and type 1 MI also increased the risk of dialysis initiation.
Conclusions:
- The invasive strategy in ISCHEMIA-CKD resulted in higher procedural MI rates but lower type 1 and 2 MI rates.
- Procedural, type 1, and type 2 MIs were linked to a higher risk of subsequent death.
- Type 1 MI significantly increased the risk for initiating dialysis.
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.
Related Concept Videos
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:21Myocarditis I: Introduction
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
01:24Chronic Kidney Disease II: Clinical Manifestations
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
01:30Coronary Artery Disease III: Clinical Manifestations