Journal article
Efficacy and safety of dual antiplatelet therapy after coronary stenting in patients with chronic kidney disease.
- Hwang D Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
- Park KW Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: kwparkmd@snu.ac.kr.
- Lee JM Department of Internal Medicine and Cardiovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Rhee TM Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
- Hong MK Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea.
- Jang Y Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea.
- Valgimigli M Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Colombo A Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
- Gilard M Département de cardiologie, CHU de la Cavale Blanche, Boulevard Tanguy Prigent, Brest Cedex, France.
- Palmerini T Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Bologna, Italy.
- Stone GW Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY.
- Kim HS Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
- 2018-02-16
Published in:
- American heart journal. - 2018
Aged
Coronary Restenosis
Drug Therapy, Combination
Drug-Eluting Stents
Female
Hemorrhage
Humans
Incidence
Male
Middle Aged
Myocardial Infarction
Myocardial Ischemia
Outcome Assessment, Health Care
Percutaneous Coronary Intervention
Platelet Aggregation Inhibitors
Renal Insufficiency, Chronic
Republic of Korea
Risk Assessment
Stroke
English
BACKGROUND
We compared efficacy and safety of short- (3 or 6 months) versus long-term (≥12 months) dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation, according to the presence of chronic kidney disease (CKD).
METHODS
Patient-level pooled analysis was performed with 7242 patients (87.2% with 2nd generation DES) from 5 randomized controlled trials.
RESULTS
In both CKD (1273 patients) and non-CKD (5969 patients) population, the rates of patient-oriented composite outcomes at 1-year (POCO, all-cause death, any myocardial infarction [MI], stroke and TIMI major bleeding) were not different between the short- and long-term DAPT (hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.76-1.86, P=.449 in CKD population; HR 1.14, 95% CI 0.83-1.56, P=.434 in non-CKD population). The rates of coronary thrombotic events (any MI and definite/probable stent thrombosis) also did not differ between short- and long-term DAPT in either CKD or non-CKD population. As for bleeding events, long-term DAPT increased the TIMI major bleeding (HR 2.91, 95% CI 1.31-6.48, P=.009) in non-CKD population. The similar trend was observed with long-term DAPT in CKD population. But it did not reach statistical significance (HR 3.15, 95% CI 0.64-15.63, P=.160).
CONCLUSIONS
The rates of POCO and coronary thrombotic events were significantly higher in patients with CKD compared with those without CKD, which were not affected by short- or long-term DAPT. Higher bleeding incidence by long-term DAPT was only observed in non-CKD patients but not in CKD patients. Further large scale studies are warranted to confirm our findings.
We compared efficacy and safety of short- (3 or 6 months) versus long-term (≥12 months) dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation, according to the presence of chronic kidney disease (CKD).
METHODS
Patient-level pooled analysis was performed with 7242 patients (87.2% with 2nd generation DES) from 5 randomized controlled trials.
RESULTS
In both CKD (1273 patients) and non-CKD (5969 patients) population, the rates of patient-oriented composite outcomes at 1-year (POCO, all-cause death, any myocardial infarction [MI], stroke and TIMI major bleeding) were not different between the short- and long-term DAPT (hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.76-1.86, P=.449 in CKD population; HR 1.14, 95% CI 0.83-1.56, P=.434 in non-CKD population). The rates of coronary thrombotic events (any MI and definite/probable stent thrombosis) also did not differ between short- and long-term DAPT in either CKD or non-CKD population. As for bleeding events, long-term DAPT increased the TIMI major bleeding (HR 2.91, 95% CI 1.31-6.48, P=.009) in non-CKD population. The similar trend was observed with long-term DAPT in CKD population. But it did not reach statistical significance (HR 3.15, 95% CI 0.64-15.63, P=.160).
CONCLUSIONS
The rates of POCO and coronary thrombotic events were significantly higher in patients with CKD compared with those without CKD, which were not affected by short- or long-term DAPT. Higher bleeding incidence by long-term DAPT was only observed in non-CKD patients but not in CKD patients. Further large scale studies are warranted to confirm our findings.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.ahj.2017.11.013
- PMID 29447770
- Persistent URL
- https://sonar.ch/global/documents/278724
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