肾功能分层：接受第三代药物洗脱支架经皮冠状动脉介入治疗患者短期与长期双重抗血小板治疗的比较——HOST-IDEA随机临床试验的事后分析

Renal Function-Stratified Comparison of Short- and Long-Term Dual Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention With Third-Generation Drug-Eluting Stents　- Post Hoc Analysis From the HOST-IDEA Randomized Clinical Trial.

作者信息

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

机构信息

Cardiovascular Center, Seoul National University Hospital.

Department of Internal Medicine, College of Medicine, Seoul National University.

出版信息

Circ J. 2025 Feb 25;89(3):281-291. doi: 10.1253/circj.CJ-24-0481. Epub 2024 Oct 12.

DOI:10.1253/circj.CJ-24-0481

PMID:39401917

Abstract

BACKGROUND

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.

METHODS AND RESULTS

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.

CONCLUSIONS

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.

摘要

背景

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。

方法与结果

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。