Hanyeo Expo Hospital, Yeosu, Korea.
Am J Cardiol. 2012 Dec 1;110(11):1598-606. doi: 10.1016/j.amjcard.2012.07.025. Epub 2012 Aug 28.
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 m(2)) 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.
在因 ST 段抬高型心肌梗死而行直接经皮冠状动脉介入治疗的慢性肾脏病患者中，氯吡格雷的最佳负荷剂量尚未得到研究。本研究旨在评估该人群中氯吡格雷负荷剂量对临床结局的影响。共评估了 1457 例 CKD 患者（估算肾小球滤过率<60ml/min/1.73m2）的氯吡格雷负荷剂量：600mg（n=861）与 300mg（n=596）。比较两组患者住院期间并发症，包括大出血和 1 个月及 12 个月时的临床结局。两组住院期间大出血发生率相似（0.8% vs 0.2%，p=0.09）。此外，1 个月（15.6% vs 16.4%，p=0.70）和 12 个月（19.0% vs 21.3%，p=0.32）时，主要不良心脏事件发生率（包括死亡、再发心肌梗死、靶病变血运重建和支架血栓形成）也无差异。多变量分析显示，氯吡格雷 600mg 负荷剂量不是 1 个月（优势比 1.13，95%置信区间 0.49 至 2.57，p=0.78）和 12 个月（优势比 0.89，95%置信区间 0.52 至 1.51，p=0.66）主要不良心脏事件的独立预测因素。经倾向评分匹配分析后，结果仍无变化。总之，在因 ST 段抬高型心肌梗死而行直接经皮冠状动脉介入治疗的慢性肾脏病患者中，氯吡格雷 600mg 负荷剂量不能有效降低 1 个月和 12 个月时的主要不良心脏事件，但该剂量并未增加住院期间大出血的发生率。
