Dual Antiplatelet Therapy and Clinical Outcomes after Coronary Drug-Eluting Stent Implantation in Patients on Hemodialysis

Clinical journal of the American Society of Nephrology: CJASN

Shuo-Ming Ou¹  Yung-Tai Chen⁴  Pei-Wen Chao⁶  Hung-Ta Chen⁸ 

[1] and..‡School of Medicine, and..‖‖Deran Clinic, Yilan, Taiwan..;**College of Medicine and..††Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan;Divisions of *Nephrology and..†Institute of Clinical Medicine,..;†Institute of Clinical Medicine,..§§Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan;†Institute of Clinical Medicine,..‖Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan;‡School of Medicine, and..;‡School of Medicine, and..§Endocrinology and Metabolism, Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan

关键词: hemodialysis;    coronary artery disease;    Epidemiology and outcomes;    Cohort;    Studies;    Drug-Eluting Stents;    Hemorrhage;    Humans;    Myocardial Infarction;    National Health Programs;    Odds Ratio;    Propensity Score;    renal dialysis;    Risk Assessment;    Stroke;    Taiwan;    Treatment Outcome;    2′-deoxythymidylyl-(3′-5′)-2′-deoxyadenosine;   

DOI  :  10.2215/CJN.04430416

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

Background and objectives We aimed to investigate the benefits and risks of dual antiplatelet therapy (DAPT) after coronary drug-eluting stent (DES) implantation in patients undergoing hemodialysis.Design, setting, participants, & measurements A nested case-control analysis of patients on hemodialysis after receipt of DES and DAPT treatment was conducted using data from Taiwan’s National Health Insurance Research Database for the period 2007–2011. Cases of myocardial infarction or death within 1 year after DES implantation were matched one-to-one with control patients. Odds ratios were calculated to compare DAPT continuation with discontinuation. Additionally, a propensity score–adjusted 6-month landmark cohort analysis was also conducted to evaluate the long-term benefits and risks of prolonged (>6 months) compared with ≤6 months of DAPT use. The primary outcomes were death and myocardial infarction. The secondary outcomes were ischemic stroke, revascularization, and major bleeding.Results In the nested case-control analysis, patients who continued DAPT had a lower rate of death or myocardial infarction within 1 year after receipt of a DES (adjusted odds ratio, 0.54; 95% confidence interval, 0.36 to 0.81; P=0.003), whereas this association became statistically nonsignificant when compared with patients who discontinued DAPT for the period between 6 and 12 months after receipt of a DES (adjusted odds ratio, 1.51; 95% confidence interval, 0.75 to 3.04). In the propensity score–adjusted cohort analysis, >6 months of DAPT use was not associated with different primary or secondary outcomes than shorter-term use.Conclusions Our findings support that the clinical effectiveness of extended DAPT in a hemodialysis population may be tempered after 6 months post-DES implantation.

【 授权许可】

CC BY