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 language | English |
|---|---|
| Pages (from-to) | 103-112 |
| Number of pages | 10 |
| Journal | American heart journal |
| Volume | 197 |
| DOIs | |
| Publication status | Published - 2018 Mar |
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All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine
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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, Myeong Ki; Jang, Yangsoo; Valgimigli, Marco; Colombo, Antonio; Gilard, Martine; Palmerini, Tullio; Stone, Gregg W.; Kim, Hyo Soo.
In: American heart journal, Vol. 197, 03.2018, p. 103-112.Research output: Contribution to journal › Article
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, Myeong Ki
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
Y1 - 2018/3
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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U2 - 10.1016/j.ahj.2017.11.013
DO - 10.1016/j.ahj.2017.11.013
M3 - Article
C2 - 29447770
AN - SCOPUS:85040005104
VL - 197
SP - 103
EP - 112
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
ER -