Han Jung-Kyu, Lee Seung Do, Hwang Doyeon, Park Sang-Hyeon, Kang Jeehoon, Yang Han-Mo, Park Kyung Woo, Kang Hyun-Jae, Koo Bon-Kwon, Cho Jin-Man, Cho Janghyun, Bang Duk Won, Lee Jae-Hwan, Lee Han Cheol, Kim Kyung-Jin, Chun Woojung, Seo Won-Woo, Park Woo-Jung, Park Sang Min, Lee Seung Jin, Kim Hyo-Soo
Cardiovascular Center, Seoul National University Hospital.
Department of Internal Medicine, College of Medicine, Seoul National University.
Circ J. 2025 Feb 25;89(3):281-291. doi: 10.1253/circj.CJ-24-0481. Epub 2024 Oct 12.
The optimal duration of dual antiplatelet therapy (DAPT) in patients with chronic kidney disease undergoing percutaneous coronary intervention (PCI), especially with third-generation drug-eluting stents (DES), remains unknown.
We conducted a prespecified post hoc analysis of the HOST-IDEA trial, randomizing patients undergoing PCI with third-generation DES to 3- to 6-month or 12-month DAPT. In all, 1,997 patients were grouped by their estimated glomerular filtration rate (eGFR): high (>90 mL/min/1.73 m), intermediate (60-90 mL/min/1.73 m), and low (<60 mL/min/1.73 m). The primary outcome was net adverse clinical events (NACE), a composite of cardiac death, target vessel myocardial infarction, clinically driven target lesion revascularization, stent thrombosis, or major bleeding (Bleeding Academic Research Consortium Type 3 or 5) at 12 months. Secondary outcomes were target lesion failure (TLF) and major bleeding. The low eGFR group had the highest rates of NACE, TLF, and major bleeding compared with the other 2 groups (P<0.001). Rates of NACE were similar in the 3- to 6-month and 12-month DAPT in the high (2.9% vs. 3.2%; P=0.84), intermediate (2.1% vs. 2.8%, P=0.51), and low (8.9% vs. 9.1%; hazard ratio 0.99; P=0.97; P=0.88) eGFR groups. TLF and major bleeding events showed similar trends.
In patients undergoing PCI with third-generation DES, 3- to 6-month DAPT was comparable to 12-month DAPT for clinical outcomes regardless of renal function.
对于接受经皮冠状动脉介入治疗（PCI）的慢性肾脏病患者，尤其是使用第三代药物洗脱支架（DES）的患者，双联抗血小板治疗（DAPT）的最佳疗程仍不清楚。
我们对HOST-IDEA试验进行了一项预先设定的事后分析，将接受第三代DES PCI的患者随机分为3至6个月或12个月DAPT组。总共1997例患者根据其估计肾小球滤过率（eGFR）分组：高（>90 mL/min/1.73 m²）、中（60-90 mL/min/1.73 m²）和低（<60 mL/min/1.73 m²）。主要结局是12个月时的净不良临床事件（NACE），这是一个由心源性死亡、靶血管心肌梗死、临床驱动的靶病变血运重建、支架血栓形成或大出血（出血学术研究联盟3型或5型）组成的复合结局。次要结局是靶病变失败（TLF）和大出血。与其他两组相比，低eGFR组的NACE、TLF和大出血发生率最高（P<0.001）。在高（2.9%对3.2%；P=0.84）、中（2.1%对2.8%，P=0.51）和低（8.9%对9.1%；风险比0.99；P=0.97；P=0.88）eGFR组中，3至6个月和12个月DAPT的NACE发生率相似。TLF和大出血事件显示出相似趋势。
对于接受第三代DES PCI的患者，无论肾功能如何，3至6个月DAPT与12个月DAPT的临床结局相当。
