Impact of Clopidogrel Loading Dose in Patients With Chronic Kidney Disease Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

Title
Impact of Clopidogrel Loading Dose in Patients With Chronic Kidney Disease Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction
Author(s)
김영조김준영[김준영]정명호[정명호]문재현[문재현]안용근[안용근]채성철[채성철]허승호[허승호]홍택종[홍택종]성인환[성인환]채인호[채인호]조명찬[조명찬]장양수[장양수]윤정한[윤정한]승기배[승기배]박승종[박승종]
Keywords
DUAL ANTIPLATELET THERAPY; DRUG-ELUTING STENT; PLATELET INHIBITION; PRIMARY ANGIOPLASTY; RENAL-FUNCTION; SHORT-TERM; TRIAL; REGISTRY; TICAGRELOR; THROMBOSIS
Issue Date
201212
Publisher
EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
Citation
AMERICAN JOURNAL OF CARDIOLOGY, v.110, no.11, pp.1598 - 1606
Abstract
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. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;110:1598-1606)
URI
http://hdl.handle.net/YU.REPOSITORY/26755http://dx.doi.org/10.1016/j.amjcard.2012.07.025
ISSN
0002-9149
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의과대학 > 내과학교실 > Articles
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