Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
Am Heart J. 2018 Mar;197:103-112. doi: 10.1016/j.ahj.2017.11.013. Epub 2017 Dec 6.
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).
Patient-level pooled analysis was performed with 7242 patients (87.2% with 2nd generation DES) from 5 randomized controlled trials.
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).
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.
我们比较了药物洗脱支架（DES）植入后短期（3 或 6 个月）与长期（≥12 个月）双联抗血小板治疗（DAPT）的疗效和安全性，根据是否存在慢性肾脏病（CKD）。
对来自 5 项随机对照试验的 7242 例患者（87.2%为第二代 DES）进行了患者水平的汇总分析。
在 CKD（1273 例）和非 CKD（5969 例）患者中，1 年时患者导向的复合结局（POCO，全因死亡、任何心肌梗死[MI]、卒中和 TIMI 大出血）的发生率在短期和长期 DAPT 之间没有差异（HR 1.19，95%CI 0.76-1.86，P=.449 在 CKD 人群中；HR 1.14，95%CI 0.83-1.56，P=.434 在非 CKD 人群中）。CKD 或非 CKD 患者中，短期和长期 DAPT 之间的冠状动脉血栓事件（任何 MI 和确定/可能的支架血栓形成）发生率也没有差异。至于出血事件，非 CKD 人群中，长期 DAPT 增加了 TIMI 大出血（HR 2.91，95%CI 1.31-6.48，P=.009）。在 CKD 人群中也观察到了与长期 DAPT 相似的趋势，但没有达到统计学意义（HR 3.15，95%CI 0.64-15.63，P=.160）。
与无 CKD 患者相比，CKD 患者的 POCO 和冠状动脉血栓事件发生率明显更高，但短期或长期 DAPT 对其没有影响。只有在非 CKD 患者中观察到长期 DAPT 会增加出血发生率，而在 CKD 患者中则没有。需要进一步进行大规模研究来证实我们的发现。
