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 (2018). Efficacy and safety of dual antiplatelet therapy after coronary stenting in patients with chronic kidney disease. American Heart Journal, 197, pp. 103-112. Elsevier 10.1016/j.ahj.2017.11.013

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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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