Key result
CKD in PCI patients linked to a ~3-fold higher 2-year mortality risk.
Why the study?
Patients with chronic kidney disease undergoing PCI have high rates of ischemic and bleeding events, complicating decisions about dual antiplatelet therapy cessation.
Does the presence of chronic kidney disease modify the risk associated with different modes of dual antiplatelet therapy cessation after percutaneous coronary intervention?
Cohort (n=4,584)
Does the presence of chronic kidney disease modify the risk associated with different modes of dual antiplatelet therapy cessation after percutaneous coronary intervention?
Hazard Ratio: 3.16 (95% CI 2.26–4.41)
While patients with CKD have higher baseline risks for ischemic and bleeding events after PCI, the risk associated with DAPT cessation is not modified by CKD status.
CKD patients show higher early DAPT discontinuation after PCI; leaves open whether tailored cessation strategies improve net outcomes in this population.
BACKGROUND: Patients with chronic kidney disease (CKD) experience high rates of ischemic and bleeding events after percutaneous coronary intervention (PCI), complicating decisions surrounding dual antiplatelet therapy (DAPT). This study aims to determine the pattern and impact of various modes of DAPT cessation for patients with CKD undergoing PCI. METHODS AND RESULTS: Patients from the PARIS registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) were grouped based on the presence of CKD defined as creatinine clearance <60 mL/min. After index PCI, time and mode of DAPT cessation (discontinuation, interruption, and disruption) and clinical outcomes (major adverse cardiac events, stent thrombosis, myocardial infarction, and major bleeding [Bleeding Academic Research Consortium type 3 or 5]) were reported. Over 2 years, patients with CKD (n=839) had higher adjusted risks for death (hazard ratio, 3.16; 95% confidence interval, 2.26-4.41), myocardial infarction (hazard ratio, 2.43; 95% confidence interval, 1.65-3.57), and major bleeding (hazard ratio, 2.21; 95% confidence interval, 1.53-3.19) compared with patients without CKD (n=3745). Rates of DAPT discontinuation within the first year after PCI and disruption were significantly higher for patients with CKD. However, DAPT interruption occurred with equal frequency. Associations between DAPT cessation mode and subsequent risk were not modified by CKD status. Findings were unchanged after propensity matching. CONCLUSIONS: Patients with CKD display high and comparable risks for both ischemic and bleeding events after PCI. Physicians are more likely to discontinue DAPT within the first year after PCI among patients with CKD, likely reflecting clinical preferences to avoid bleeding. Risks after DAPT cessation, irrespective of underlying mode, are not modified by the presence or absence of CKD.
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Baber et al. (2018) conducted a cohort in Percutaneous coronary intervention (n=4,584). Chronic kidney disease vs. No chronic kidney disease was evaluated on Death (HR 3.16, 95% CI 2.26-4.41). Chronic kidney disease in patients undergoing PCI was associated with a significantly higher risk of death (HR 3.16; 95% CI 2.26-4.41) over 2 years compared to patients without CKD.
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