Key result
Long-term dual antiplatelet therapy (>6 months) was associated with a similar risk of major adverse cardiovascular events compared to short-term therapy (≤6 months) in patients with chronic kidney disease after coronary stenting (HR 1.05).
Why the study?
Although DAPT is standard after stent implantation, the optimal duration remains elusive in patients with chronic kidney disease.
Does long-term DAPT reduce MACE in patients with CKD after coronary stenting compared to short-term DAPT?
Cohort (n=1,899)
Yes
Does long-term DAPT reduce MACE in patients with CKD after coronary stenting compared to short-term DAPT?
Hazard Ratio: 1.05 (95% CI 0.65–1.7)
Absolute Event Rate: 3% vs 2.8%
p-value: p=0.83
In patients with CKD undergoing coronary stenting, long-term DAPT (>6 months) showed similar rates of MACE, all-cause mortality, and bleeding compared to short-term DAPT (≤6 months).
Similar MACE risk with long- versus short-term DAPT in CKD warrants no practice change; leaves optimal duration open for RCTs.
BACKGROUND: Dual antiplatelet therapy (DAPT) is currently the standard treatment for the prevention of ischemic events after stent implantation. However, the optimal DAPT duration remains elusive for patients with chronic kidney disease (CKD). Therefore, we aimed to compare the effectiveness and safety between long-term and short-term DAPT after coronary stenting in patients with CKD. METHODS: This retrospective cohort study analyze data from the Taipei Medical University (TMU) Institutional and Clinical Database, which include anonymized electronic health data of 3 million patients that visited TMU Hospital, Wan Fang Hospital, and Shuang Ho Hospital. We enrolled patients with CKD after coronary stenting between 2008 and 2019. The patients were divided into the long-term (>6 months) and short-term DAPT group (≤ 6 months). The primary end point was major adverse cardiovascular events (MACE) from 6 months after the index date. The secondary outcomes were all-cause mortality and Thrombolysis in Myocardial Infarction (TIMI) bleeding. RESULTS: A total of 1899 patients were enrolled; of them, 1112 and 787 were assigned to the long-term and short-term DAPT groups, respectively. Long-term DAPT was associated with similar risk of MACE (HR: 1.05, 95% CI: 0.65-1.70, P = 0.83) compare with short-term DAPT. Different CKD risk did not modify the risk of MACE. There was also no significant difference in all-cause mortality (HR: 1.10, 95% CI: 0.75-1.61, P = 0.63) and TIMI bleeding (HR 1.19, 95% CI: 0.86-1.63, P = 0.30) between groups. CONCLUSIONS: Among patients with CKD and coronary stenting, we found that long-term and short-term DAPT tied on the risk of MACE, all-cause mortality and TIMI bleeding.
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Kao et al. (2021) conducted a cohort in Chronic kidney disease after coronary stenting (n=1,899). Long-term dual antiplatelet therapy (>6 months) vs. Short-term dual antiplatelet therapy (≤6 months) was evaluated on Major adverse cardiovascular events (MACE) from 6 months after the index date (HR 1.05, 95% CI 0.65-1.70, p=0.83). Long-term dual antiplatelet therapy (>6 months) was associated with a similar risk of major adverse cardiovascular events compared to short-term therapy (≤6 months) in patients with chronic kidney disease after coronary stenting (HR 1.05).
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