High-dose intravenous (IV) iron reduces the risk for acute myocardial infarction in patients receiving maintenance hemodialysis compared with low-dose IV iron, investigators report.
The findings are from both a prespecified and post hoc analysis of the Proactive IV Iron Therapy in Hemodialysis Patients (PIVOTAL) randomized trial, which included 2141 patients with a ferritin concentration less than 400 µg per liter and a transferrin saturation less than 30%. Over a median 2.1 years, 8.4% of patients experienced a fatal or nonfatal myocardial infarction (MI). Fewer first MIs occurred in the high-dose than low-dose IV iron group: 3.5 vs 4.9 events per 100 person-years. In time-to-first event analyses, proactive high-dose IV iron reduced the risk for non-fatal and fatal MI by a significant 31% compared with reactive low-dose IV iron, Mark C Petrie, MD, of the University of Glasgow in Glasgow, UK, and colleagues reported in Cardiovascular Research. High-dose IV iron reduced the risk for type 1 MI by a significant 29% but did not reduce the risk for non-fatal type 2 MIs. With respect to recurrent events, high-dose IV iron only reduced the risk for fatal and non-fatal type 1 non-ST elevation MIs.
Overall, type 1 MIs occurred at a 2.5-fold higher rate compared with type 2 MIs: 3.2 vs 1.3 per 100 patient-years, the investigators reported. Non-ST-elevation MIs occurred at a more than 6-fold higher rate compared with ST-elevation MIs: 3.3 vs 0.5 per 100 patient-years.
Non-fatal MI was associated with 40% mortality at 1 year and 60% mortality at 2 years.
“Until the current trial, no treatment had been shown to reduce acute MI in patients receiving haemodialysis,” Dr Petrie’s team wrote.
Disclosure: This research was supported by Kidney Research UK, which was funded by an unrestricted grant from Vifor Fresenius Medical Care Renal Pharma. Please see the original reference for a full list of disclosures.
Petrie MC, Jhund PS, Connolly E, et al. High-dose intravenous iron reduces myocardial infarction in patients on haemodialysis. Cardiovasc Res. Published online December 7, 2022. doi:10.1093/cvr/cvab317