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Clopidogrel Versus Aspirin as Chronic Maintenance Antiplatelet Monotherapy in Patients After Percutaneous Coronary Intervention With Chronic Kidney Disease: A Post Hoc Analysis of the HOST-EXAM Trial.
Kang, Jeehoon; Park, Sang-Hyeon; Park, Kyung Woo; Koo, Bon-Kwon; Lee, Huijin; Han, Minju; Hwang, Doyeon; Yang, Han-Mo; Chae, In-Ho; Shin, Won-Yong; Oh, Ju Hyeon; Kim, Yong Hoon; Park, Tae-Ho; Kim, Bum Soo; Han, Jung-Kyu; Shin, Eun-Seok; Kim, Hyo-Soo.
Afiliación
  • Kang J; Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea.
  • Park SH; Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea.
  • Park KW; Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea.
  • Koo BK; Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea.
  • Lee H; Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea.
  • Han M; Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea.
  • Hwang D; Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea.
  • Yang HM; Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea.
  • Chae IH; Department of Internal Medicine Seoul National University Bundang Hospital Seongnam South Korea.
  • Shin WY; Department of Internal Medicine Soonchunhyang University Cheonan Hospital Cheonan South Korea.
  • Oh JH; Department of Cardiology, Samsung Changwon Hospital Sungkyunkwan University School of Medicine Changwon South Korea.
  • Kim YH; Department of Internal Medicine Kangwon National University School of Medicine Chuncheon South Korea.
  • Park TH; Department of Internal Medicine Dong-A University Hospital Busan South Korea.
  • Kim BS; Department of Internal Medicine, Kangbuk Samsung Hospital Sungkyunkwan University Seoul South Korea.
  • Han JK; Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea.
  • Shin ES; Department of Internal Medicine Ulsan University Hospital Ulsan South Korea.
  • Kim HS; Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea.
J Am Heart Assoc ; 13(18): e035269, 2024 Sep 17.
Article en En | MEDLINE | ID: mdl-39248265
ABSTRACT

BACKGROUND:

Clopidogrel monotherapy improved clinical outcomes compared with aspirin monotherapy during a chronic maintenance period in patients who underwent coronary stenting in the HOST-EXAM (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Extended Antiplatelet Monotherapy) trial. However, it is uncertain whether the beneficial effect of clopidogrel over aspirin is different according to the renal function. METHODS AND

RESULTS:

We conducted a post hoc analysis of the HOST-EXAM trial. Chronic kidney disease (CKD) was defined as baseline estimated glomerular filtration rate <60 mL/min per 1.73 m2. The primary end point was a composite of all-cause death, nonfatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and Bleeding Academic Research Consortium bleeding type ≥3, during the 2-year follow up. Among the 5438 patients enrolled in the HOST-EXAM trial, 4844 patients (mean age, 63.3±10.6 years; 74.9% men) with a baseline creatinine value were analyzed in this study. A total of 508 (10.5%) patients had CKD, who were at higher risk of the primary end point compared with those without CKD (hazard ratio [HR], 2.01 [95% CI, 1.51-2.67]). Clopidogrel monotherapy was associated with a lower rate of the primary end point in both patients with CKD (HR, 0.74 [95% CI, 0.44-1.25]) and patients without CKD (HR, 0.71 [95% CI, 0.56-0.91]). No significant interaction was observed between the treatment effect and CKD status (P for interaction=0.889).

CONCLUSIONS:

During the chronic maintenance period after coronary stenting, the risk of thrombotic and bleeding events was significantly higher in patients with CKD compared with those without CKD. There was no statistical difference in the treatment effect of clopidogrel monotherapy in those with versus without CKD.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Inhibidores de Agregación Plaquetaria / Aspirina / Insuficiencia Renal Crónica / Intervención Coronaria Percutánea / Clopidogrel Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Am Heart Assoc Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Inhibidores de Agregación Plaquetaria / Aspirina / Insuficiencia Renal Crónica / Intervención Coronaria Percutánea / Clopidogrel Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Am Heart Assoc Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido