The SYMPHONY Trial Reference Reddan DN, et al. Renal function, concomitant medication use and outcomes following acute coronary syndromes. Nephrol Dial Transplant. 2005;20:2105–2112. Sibrafiban Versus Aspirin to Yield Maximum Protection from Ischemic Heart Events Post-acute Coronary Syndromes

Background Chronic kidney disease (CKD) is highly prevalent in patients with cardiovascular disease. We explored the associations of CKD with outcomes using combined data from two large acute coronary syndrome (ACS) trials. The associations of CKD with prescription patterns for common cardiovascular medications and the association of these prescription patterns with clinical outcomes were explored.

Aim To compare sibrafiban and aspirin for protection offered in ischemic heart events post-ACS.

Method Study design: The SYMPHONY trial was a randomized double-blind study. Study population: A total of 9233 patients participated in this trial. Treatment regimen: 9233 patients were randomly assigned either aspirin orally 80 mg twice a day or sibrafiban either low dose or high dose twice daily for 90 days. In the 2nd SYMPHONY trial, patients were randomized to receive aspirin 80 mg orally, low-dose sibrafabin plus aspirin 80 mg, or high- dose sibrafabin alone twice daily. End point: Death or myocardial infarction.

Result 6840 patients had stage I, 5909 were categorized in stage II, 955 were in stage III and 3 were in stage IV. The study mostly involves females or older people who were non-smokers and had a co-morbid disease such as hypertension, congestive heart failure and diabetes mellitus. Patients with CKD usually receive cardiovascular medications less frequently. However, with increase in CrCl levels the risk of mortality was greatly reduced. The effect of medications on CKD and overall mortality is described by diagrams as given below.