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Ticagrelor vs. Clopidogrel in Acute Coronary Syndrome Patients With Chronic Kidney Disease After New-Generation Drug-Eluting Stent Implantation

Authors
 Ji Woong Roh  ;  Seung-Jun Lee  ;  Byeong-Keuk Kim  ;  Sung-Jin Hong  ;  Hee-Yeol Kim  ;  Chul-Min Ahn  ;  Deok-Kyu Cho  ;  Jung-Sun Kim  ;  Young-Guk Ko  ;  Donghoon Choi  ;  Myeong-Ki Hong  ;  Yangsoo Jang 
Citation
 FRONTIERS IN CARDIOVASCULAR MEDICINE, Vol.8 : 707722, 2022-01 
Journal Title
FRONTIERS IN CARDIOVASCULAR MEDICINE
Issue Date
2022-01
Keywords
ticagrelor ; clopidogrel ; acute coronary syndrome ; renal insufficiency ; drug eluting stents
Abstract
Background: The impact of ticagrelor-based dual antiplatelet therapy (DAPT) on acute
coronary syndrome (ACS) in patients with chronic kidney disease (CKD) remains unclear.
Methods: Data on a total of 1,067 ACS patients with CKD including end-stage renal
disease (ESRD) who underwent new-generation drug-eluting stent implantation were
extracted from a multicenter registry. This study aimed to compare outcomes of patients
treated with ticagrelor- (n = 449) and those treated with clopidogrel-based (n = 618)
DAPT. Outcomes of interest included major adverse cardiac and cerebrovascular events
(MACCEs) and bleeding (Bleeding Academic Research Consortium grade 3 or 5) at 12
months. Propensity-score matching (346 pairs) analysis was performed.
Results: The patients with ESRD showed the highest MACCE and bleeding
rates (P < 0.001). There was no difference in the rate of MACCEs between the
treatment groups (7.8% vs. 8.4%; hazard ratio [HR] = 0.95, 95% confidence interval
[CI] = 0.56–1.61, P = 0.855); however, a trend toward an increased bleeding rate
was observed in the ticagrelor-based DAPT group (6.8% vs. 3.8%, HR = 1.84, 95%
CI = 0.93–3.63, P = 0.079). Among patients with CKD stage III/IV but without ESRD
(277 pairs), the ticagrelor-based DAPT group showed a reduced MACCE rate (3.6% vs.
8.7%, HR = 0.41, 95% CI = 0.19–0.86, P = 0.018) and a similar bleeding rate (5.1%
vs. 3.2%, HR = 1.61, 95% CI = 0.70–3.71, P = 0.267), compared with those of the
clopidogrel-based DAPT group.
Conclusion: The effects of ticagrelor-based DAPT on ischemic and bleeding outcomes
of ACS patients with CKD varied according to CKD stage; in ACS patients with CKD
without ESRD, ticagrelor-based DAPT reduced MACCE risk without increasing bleeding
risks, relative to those observed with clopidogrel-based DAPT.
Files in This Item:
T202200322.pdf Download
DOI
10.3389/fcvm.2021.707722
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Roh, Ji Woong(노지웅)
Ahn, Chul-Min(안철민) ORCID logo https://orcid.org/0000-0002-7071-4370
Lee, Seung-Jun(이승준) ORCID logo https://orcid.org/0000-0002-9201-4818
Cho, Deok Kyu(조덕규)
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
Hong, Sung Jin(홍성진) ORCID logo https://orcid.org/0000-0003-4893-039X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/187954
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