Impact of clopidogrel loading dose in patients with chronic kidney disease undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction

Joon Young Kim, Myung Ho Jeong, Jae Hyun Moon, Yong Keun Ahn, Shung Chull Chae, Seung Ho Hur, Taek Jong Hong, Young Jo Kim, In Whan Seong, In Ho Chae, Myeong Chan Cho, Yang Soo Jang, Jung Han Yoon, Ki Bae Seung, Seung Jung Park

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Abstract

The optimal loading dose of clopidogrel in patients with chronic kidney disease who undergo primary percutaneous coronary intervention for ST-segment elevation myocardial infarction has not been investigated. The aim of this study was to assess the impact of clopidogrel loading dose on clinical outcomes in this setting. A total of 1,457 patients with CKD (estimated glomerular filtration rate <60 ml/min/1.73 m2) were evaluated according to clopidogrel loading dose: 600 mg (n = 861) versus 300 mg (n = 596). In-hospital complications, including major bleeding and clinical outcomes at 1 and 12 months, were compared between the 2 groups. The in-hospital major bleeding rate was similar (0.8% vs 0.2%, p = 0.09). Also, there were no differences in major adverse cardiac event rates, including death, recurrent myocardial infarction, target lesion revascularization, and stent thrombosis, at 1 month (15.6% vs 16.4%, p = 0.70) and 12 months (19.0% vs 21.3%, p = 0.32). On multivariate analysis, a 600-mg loading dose of clopidogrel was not an independent predictor of 1-month (odds ratio 1.13, 95% confidence interval 0.49 to 2.57, p = 0.78) and 12-month (odds ratio 0.89, 95% confidence interval 0.52 to 1.51, p = 0.66) major adverse cardiac events. After propensity score-matched analysis, these results were unchanged. In conclusion, a 600-mg loading dose of clopidogrel was not effective in reducing 1- and 12-month major adverse cardiac events in patients with chronic kidney disease who underwent primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, but this dose did not increase the in-hospital major bleeding rate.

Original languageEnglish
Pages (from-to)1598-1606
Number of pages9
JournalAmerican Journal of Cardiology
Volume110
Issue number11
DOIs
Publication statusPublished - 2012 Dec 1

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Kim, J. Y., Jeong, M. H., Moon, J. H., Ahn, Y. K., Chae, S. C., Hur, S. H., Hong, T. J., Kim, Y. J., Seong, I. W., Chae, I. H., Cho, M. C., Jang, Y. S., Yoon, J. H., Seung, K. B., & Park, S. J. (2012). Impact of clopidogrel loading dose in patients with chronic kidney disease undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. American Journal of Cardiology, 110(11), 1598-1606. https://doi.org/10.1016/j.amjcard.2012.07.025