High-dose intravenous iron reduces myocardial infarction in patients on haemodialysis

Petrie, M. C. et al. (2021) High-dose intravenous iron reduces myocardial infarction in patients on haemodialysis. Cardiovascular Research, (doi: 10.1093/cvr/cvab317) (PMID:34875022) (Early Online Publication)

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Abstract

Aims: To investigate the effect of high-dose iron vs. low-dose intravenous (IV) iron on myocardial infarction (MI) in patients on maintenance haemodialysis. Methods and results: This was a pre-specified analysis of secondary endpoints of the Proactive IV Iron Therapy in Hemodialysis Patients trial (PIVOTAL) randomized, controlled clinical trial. Adults who had started haemodialysis within the previous year, who had a ferritin concentration <400 μg per litre and a transferrin saturation <30% were randomized to high-dose or low-dose IV iron. The main outcome measure for this analysis was fatal or non-fatal MI. Over a median of 2.1 years of follow-up, 8.4% experienced a MI. Rates of type 1 MIs (3.2/100 patient-years) were 2.5 times higher than type 2 MIs (1.3/100 patient-years). Non-ST-elevation MIs (3.3/100 patient-years) were 6 times more common than ST-elevation MIs (0.5/100 patient-years). Mortality was high after non-fatal MI (1- and 2-year mortality of 40% and 60%, respectively). In time-to-first event analyses, proactive high-dose IV iron reduced the composite endpoint of non-fatal and fatal MI [hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.52–0.93, P = 0.01] and non-fatal MI (HR 0.69, 95% CI 0.51–0.93; P = 0.01) when compared with reactive low-dose IV iron. There was less effect of high-dose IV iron on recurrent MI events than on the time-to-first event analysis. Conclusion: In total, 8.4% of patients on maintenance haemodialysis had an MI over 2 years. High-dose compared to low-dose IV iron reduced MI in patients receiving haemodialysis. EudraCT Registration Number: 2013-002267-25.

Item Type:Articles
Additional Information:Supported by Kidney Research UK, which was supported by an unrestricted grant from Vifor 328 Fresenius Medical Care Renal Pharma. MCP and JJMcM are supported by a British Heart 329 Foundation Centre of Research Excellence Grant RE/18/6/34217.
Status:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mark, Professor Patrick and Petrie, Professor Mark and Robertson, Mrs Michele and McMurray, Professor John and Ford, Professor Ian and Jhund, Dr Pardeep and Connolly, Dr Eugene
Authors: Petrie, M. C., Jhund, P. S., Connolly, E., Mark, P. B., MacDonald, M. R., Robertson, M., Anker, S. D., Bhandari, S., Farrington, K., Kalra, P. A., Wheeler, D. C., Tomson, C. R.V., Ford, I., McMurray, J. J.V., and Macdougall, I. C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:Cardiovascular Research
Publisher:Oxford University Press
ISSN:0008-6363
ISSN (Online):1755-3245
Published Online:07 December 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Cardiovascular Research 2021
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceColin BerryBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science