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Benefit and risk of prolonged dual antiplatelet therapy after drug-eluting stent implantation in patients with chronic kidney disease: A nationwide cohort study

Authors
 Choongki Kim  ;  Dong-Woo Choi  ;  Seung-Jun Lee  ;  Yongsung Suh  ;  Sung-Jin Hong  ;  Chul-Min Ahn  ;  Jung-Sun Kim  ;  Byeong-Keuk Kim  ;  Young-Guk Ko  ;  Donghoon Choi  ;  Eun-Cheol Park  ;  Yangsoo Jang  ;  Chung-Mo Nam  ;  Myeong-Ki Hong 
Citation
 ATHEROSCLEROSIS, Vol.352 : 69-75, 2022-07 
Journal Title
ATHEROSCLEROSIS
ISSN
 0021-9150 
Issue Date
2022-07
MeSH
Cohort Studies ; Coronary Artery Disease* / chemically induced ; Coronary Artery Disease* / complications ; Coronary Artery Disease* / therapy ; Drug Therapy, Combination ; Drug-Eluting Stents* / adverse effects ; Hemorrhage / chemically induced ; Humans ; Myocardial Infarction* / complications ; Percutaneous Coronary Intervention* / adverse effects ; Platelet Aggregation Inhibitors / adverse effects ; Renal Insufficiency, Chronic* / complications ; Renal Insufficiency, Chronic* / diagnosis ; Retrospective Studies ; Time Factors ; Treatment Outcome
Keywords
Chronic kidney disease ; Drug-eluting stents ; Dual antiplatelet therapy ; Percutaneous coronary intervention
Abstract
Background and aims: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stent in patients with chronic kidney disease (CKD) is not clearly established. This study purposed to compare clinical outcomes of patients with 6-12 (standard) versus 12-24 months (prolonged) DAPT according to CKD.

Methods: Using a nationwide, claim-based database, we retrospectively evaluated association between DAPT duration and clinical outcomes including death, composite ischemic event, and composite bleeding event between 1 and 3 years after PCI. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2. Of 73,941 eligible patients, 13,425 (18.2%) had CKD and 49,019 (66%) were prescribed prolonged DAPT. Prolonged DAPT had no significant impact on the risk of clinical outcomes in patients with normal renal function.

Results: In patients with CKD, prolonged DAPT was associated with a lower risk of all-cause death (HR 0.85, 95% CI 0.76-0.95) and composite ischemic events (HR 0.87, 95% CI 0.78-0.96) and a higher risk of composite bleeding events (HR 1.18, 95% CI 1.02-1.37). Benefit of prolonged DAPT on reducing composite ischemic event increased significantly in patients with worsened renal dysfunction (pinteraction = 0.02) while there was no significant interaction between its bleeding risk and renal dysfunction (pinteraction = 0.22).

Conclusions: While standard DAPT would be recommended in patients with normal renal function, tailored decision for DAPT duration would be considered in those with CKD to balance between ischemic and bleeding risks.
Full Text
https://www.sciencedirect.com/science/article/pii/S0021915022002726?via%3Dihub
DOI
10.1016/j.atherosclerosis.2022.05.019
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 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
Nam, Chung Mo(남정모) ORCID logo https://orcid.org/0000-0003-0985-0928
Park, Eun-Cheol(박은철) ORCID logo https://orcid.org/0000-0002-2306-5398
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
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/22282913/189344
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