Efficacy and safety of dual antiplatelet therapy after coronary stenting in patients with chronic kidney disease

Doyeon Hwang, Kyung Woo Park, Joo Myung Lee, Tae Min Rhee, Myeongki Hong, Yangsoo Jang, Marco Valgimigli, Antonio Colombo, Martine Gilard, Tullio Palmerini, Gregg W. Stone, Hyo Soo Kim

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Abstract

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.

Original languageEnglish
Pages (from-to)103-112
Number of pages10
JournalAmerican heart journal
Volume197
DOIs
Publication statusPublished - 2018 Mar 1

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Chronic Renal Insufficiency
Kidney Diseases
Safety
Confidence Intervals
Hemorrhage
Population
Drug-Eluting Stents
Therapeutics
Myocardial Infarction
Stents
Cause of Death
Thrombosis
Randomized Controlled Trials
Stroke
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Hwang, Doyeon ; Park, Kyung Woo ; Lee, Joo Myung ; Rhee, Tae Min ; Hong, Myeongki ; Jang, Yangsoo ; Valgimigli, Marco ; Colombo, Antonio ; Gilard, Martine ; Palmerini, Tullio ; Stone, Gregg W. ; Kim, Hyo Soo. / Efficacy and safety of dual antiplatelet therapy after coronary stenting in patients with chronic kidney disease. In: American heart journal. 2018 ; Vol. 197. pp. 103-112.
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title = "Efficacy and safety of dual antiplatelet therapy after coronary stenting in patients with chronic kidney disease",
abstract = "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.",
author = "Doyeon Hwang and Park, {Kyung Woo} and Lee, {Joo Myung} and Rhee, {Tae Min} and Myeongki Hong and Yangsoo Jang and Marco Valgimigli and Antonio Colombo and Martine Gilard and Tullio Palmerini and Stone, {Gregg W.} and Kim, {Hyo Soo}",
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Hwang, D, Park, KW, Lee, JM, Rhee, TM, Hong, M, Jang, Y, Valgimigli, M, Colombo, A, Gilard, M, Palmerini, T, Stone, GW & Kim, HS 2018, 'Efficacy and safety of dual antiplatelet therapy after coronary stenting in patients with chronic kidney disease', American heart journal, vol. 197, pp. 103-112. https://doi.org/10.1016/j.ahj.2017.11.013

Efficacy and safety of dual antiplatelet therapy after coronary stenting in patients with chronic kidney disease. / Hwang, Doyeon; Park, Kyung Woo; Lee, Joo Myung; Rhee, Tae Min; Hong, Myeongki; Jang, Yangsoo; Valgimigli, Marco; Colombo, Antonio; Gilard, Martine; Palmerini, Tullio; Stone, Gregg W.; Kim, Hyo Soo.

In: American heart journal, Vol. 197, 01.03.2018, p. 103-112.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Efficacy and safety of dual antiplatelet therapy after coronary stenting in patients with chronic kidney disease

AU - Hwang, Doyeon

AU - Park, Kyung Woo

AU - Lee, Joo Myung

AU - Rhee, Tae Min

AU - Hong, Myeongki

AU - Jang, Yangsoo

AU - Valgimigli, Marco

AU - Colombo, Antonio

AU - Gilard, Martine

AU - Palmerini, Tullio

AU - Stone, Gregg W.

AU - Kim, Hyo Soo

PY - 2018/3/1

Y1 - 2018/3/1

N2 - 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.

AB - 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.

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