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Outcomes with prolonged clopidogrel therapy after coronary stenting in patients with chronic kidney disease

ObjectivesPatients with chronic kidney disease (CKD) are at high risk of death or myocardial infarction (MI) after percutaneous coronary interventions (PCI). We assessed whether prolonged dual antiplatelet therapy beyond the recommended 12 months may prevent adverse outcomes in patients with CKD rec... Full description

Journal Title: Heart (British Cardiac Society) 2015-10, Vol.101 (19), p.1569-1576
Main Author: Siddiqi, Omar K
Other Authors: Smoot, Kyle J , Dufour, Alyssa B , Cho, Kelly , Young, Melissa , Gagnon, David R , Ly, Samantha , Temiyasathit, Sara , Faxon, David P , Gaziano, J Michael , Kinlay, Scott
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: England: British Medical Association
ID: ISSN: 1355-6037
Link: https://www.ncbi.nlm.nih.gov/pubmed/26209334
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recordid: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4580134
title: Outcomes with prolonged clopidogrel therapy after coronary stenting in patients with chronic kidney disease
format: Article
creator:
  • Siddiqi, Omar K
  • Smoot, Kyle J
  • Dufour, Alyssa B
  • Cho, Kelly
  • Young, Melissa
  • Gagnon, David R
  • Ly, Samantha
  • Temiyasathit, Sara
  • Faxon, David P
  • Gaziano, J Michael
  • Kinlay, Scott
subjects:
  • Abridged Index Medicus
  • Aged
  • Aged, 80 and over
  • Angiography
  • Article
  • Aspirin
  • Cardiovascular disease
  • Care and treatment
  • Chronic kidney failure
  • Clinical outcomes
  • Clopidogrel
  • Coronary Artery Disease - complications
  • Coronary Artery Disease - diagnosis
  • Coronary Artery Disease - mortality
  • Coronary Artery Disease - therapy
  • Coronary vessels
  • Databases
  • Diabetes
  • Dosage and administration
  • Drug Administration Schedule
  • Drug-Eluting Stents
  • Female
  • Glomerular Filtration Rate
  • Heart attacks
  • Heart failure
  • Humans
  • Hypertension
  • Kidney - physiopathology
  • Kidney diseases
  • Male
  • Medicare
  • Metals
  • Middle Aged
  • Mortality
  • Multivariate Analysis
  • Myocardial Infarction - etiology
  • Patient outcomes
  • Percutaneous Coronary Intervention - adverse effects
  • Percutaneous Coronary Intervention - instrumentation
  • Percutaneous Coronary Intervention - mortality
  • Platelet Aggregation Inhibitors - administration & dosage
  • Platelet Aggregation Inhibitors - adverse effects
  • Propensity Score
  • Proportional Hazards Models
  • Prosthesis Design
  • Renal Insufficiency, Chronic - complications
  • Renal Insufficiency, Chronic - diagnosis
  • Renal Insufficiency, Chronic - mortality
  • Renal Insufficiency, Chronic - physiopathology
  • Risk Assessment
  • Risk Factors
  • Sensitivity analysis
  • Stents
  • Studies
  • Ticlopidine - administration & dosage
  • Ticlopidine - adverse effects
  • Ticlopidine - analogs & derivatives
  • Time Factors
  • Treatment Outcome
  • United States
  • United States Department of Veterans Affairs
  • Usage
ispartof: Heart (British Cardiac Society), 2015-10, Vol.101 (19), p.1569-1576
description: ObjectivesPatients with chronic kidney disease (CKD) are at high risk of death or myocardial infarction (MI) after percutaneous coronary interventions (PCI). We assessed whether prolonged dual antiplatelet therapy beyond the recommended 12 months may prevent adverse outcomes in patients with CKD receiving drug-eluting stents (DES) or bare-metal stents (BMS).MethodsWe studied all Veterans receiving PCI with BMS or first-generation DES in the Veterans Affairs (VA) Healthcare System between 2002 and 2006, classified by CKD (estimated glomerular filtration rate
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 1355-6037
fulltext: fulltext
issn:
  • 1355-6037
  • 1468-201X
url: Link


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titleOutcomes with prolonged clopidogrel therapy after coronary stenting in patients with chronic kidney disease
sourceAlma/SFX Local Collection
creatorSiddiqi, Omar K ; Smoot, Kyle J ; Dufour, Alyssa B ; Cho, Kelly ; Young, Melissa ; Gagnon, David R ; Ly, Samantha ; Temiyasathit, Sara ; Faxon, David P ; Gaziano, J Michael ; Kinlay, Scott
creatorcontribSiddiqi, Omar K ; Smoot, Kyle J ; Dufour, Alyssa B ; Cho, Kelly ; Young, Melissa ; Gagnon, David R ; Ly, Samantha ; Temiyasathit, Sara ; Faxon, David P ; Gaziano, J Michael ; Kinlay, Scott
descriptionObjectivesPatients with chronic kidney disease (CKD) are at high risk of death or myocardial infarction (MI) after percutaneous coronary interventions (PCI). We assessed whether prolonged dual antiplatelet therapy beyond the recommended 12 months may prevent adverse outcomes in patients with CKD receiving drug-eluting stents (DES) or bare-metal stents (BMS).MethodsWe studied all Veterans receiving PCI with BMS or first-generation DES in the Veterans Affairs (VA) Healthcare System between 2002 and 2006, classified by CKD (estimated glomerular filtration rate <60 mL/min) or normal renal function. We used landmark analyses from 12 months after PCI with Cox proportional hazards multivariable and propensity-adjusted models to assess the effect of prolonged clopidogrel (more than 12 months) versus 12 months or less after PCI on clinical outcomes from 1 year to 4 years after PCI.ResultsOf 23 042 eligible subjects receiving PCI, 4880 (21%) had CKD. Compared with normal renal function, patients with CKD had higher risks of death or MI 1–4 years after DES (21% vs 12%, HR=1.75; 95% CI 1.51 to 2.04) or BMS (28% vs 15%, HR=2.10; 95% CI 1.90 to 2.32). In patients with CKD receiving DES, clopidogrel use of more than 12 months after PCI was associated with lower risks of death or MI (18% vs 24%, HR=0.74; 95% CI 0.58 to 0.95), and death (15% vs 23%, HR=0.61; 95% CI 0.47 to 0.80), but had no effect on repeat revascularisation 1–4 years after PCI.ConclusionsIn patients with CKD, prolonging clopidogrel beyond 12 months after PCI may decrease the risk of death or MI only in patients receiving first-generation DES. These results support a patient-tailored approach to prolonging clopidogrel after PCI.
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subjectAbridged Index Medicus ; Aged ; Aged, 80 and over ; Angiography ; Article ; Aspirin ; Cardiovascular disease ; Care and treatment ; Chronic kidney failure ; Clinical outcomes ; Clopidogrel ; Coronary Artery Disease - complications ; Coronary Artery Disease - diagnosis ; Coronary Artery Disease - mortality ; Coronary Artery Disease - therapy ; Coronary vessels ; Databases ; Diabetes ; Dosage and administration ; Drug Administration Schedule ; Drug-Eluting Stents ; Female ; Glomerular Filtration Rate ; Heart attacks ; Heart failure ; Humans ; Hypertension ; Kidney - physiopathology ; Kidney diseases ; Male ; Medicare ; Metals ; Middle Aged ; Mortality ; Multivariate Analysis ; Myocardial Infarction - etiology ; Patient outcomes ; Percutaneous Coronary Intervention - adverse effects ; Percutaneous Coronary Intervention - instrumentation ; Percutaneous Coronary Intervention - mortality ; Platelet Aggregation Inhibitors - administration & dosage ; Platelet Aggregation Inhibitors - adverse effects ; Propensity Score ; Proportional Hazards Models ; Prosthesis Design ; Renal Insufficiency, Chronic - complications ; Renal Insufficiency, Chronic - diagnosis ; Renal Insufficiency, Chronic - mortality ; Renal Insufficiency, Chronic - physiopathology ; Risk Assessment ; Risk Factors ; Sensitivity analysis ; Stents ; Studies ; Ticlopidine - administration & dosage ; Ticlopidine - adverse effects ; Ticlopidine - analogs & derivatives ; Time Factors ; Treatment Outcome ; United States ; United States Department of Veterans Affairs ; Usage
ispartofHeart (British Cardiac Society), 2015-10, Vol.101 (19), p.1569-1576
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0Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
1Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
2Copyright: 2015 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
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1Smoot, Kyle J
2Dufour, Alyssa B
3Cho, Kelly
4Young, Melissa
5Gagnon, David R
6Ly, Samantha
7Temiyasathit, Sara
8Faxon, David P
9Gaziano, J Michael
10Kinlay, Scott
title
0Outcomes with prolonged clopidogrel therapy after coronary stenting in patients with chronic kidney disease
1Heart (British Cardiac Society)
addtitleHeart
descriptionObjectivesPatients with chronic kidney disease (CKD) are at high risk of death or myocardial infarction (MI) after percutaneous coronary interventions (PCI). We assessed whether prolonged dual antiplatelet therapy beyond the recommended 12 months may prevent adverse outcomes in patients with CKD receiving drug-eluting stents (DES) or bare-metal stents (BMS).MethodsWe studied all Veterans receiving PCI with BMS or first-generation DES in the Veterans Affairs (VA) Healthcare System between 2002 and 2006, classified by CKD (estimated glomerular filtration rate <60 mL/min) or normal renal function. We used landmark analyses from 12 months after PCI with Cox proportional hazards multivariable and propensity-adjusted models to assess the effect of prolonged clopidogrel (more than 12 months) versus 12 months or less after PCI on clinical outcomes from 1 year to 4 years after PCI.ResultsOf 23 042 eligible subjects receiving PCI, 4880 (21%) had CKD. Compared with normal renal function, patients with CKD had higher risks of death or MI 1–4 years after DES (21% vs 12%, HR=1.75; 95% CI 1.51 to 2.04) or BMS (28% vs 15%, HR=2.10; 95% CI 1.90 to 2.32). In patients with CKD receiving DES, clopidogrel use of more than 12 months after PCI was associated with lower risks of death or MI (18% vs 24%, HR=0.74; 95% CI 0.58 to 0.95), and death (15% vs 23%, HR=0.61; 95% CI 0.47 to 0.80), but had no effect on repeat revascularisation 1–4 years after PCI.ConclusionsIn patients with CKD, prolonging clopidogrel beyond 12 months after PCI may decrease the risk of death or MI only in patients receiving first-generation DES. These results support a patient-tailored approach to prolonging clopidogrel after PCI.
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1Aged
2Aged, 80 and over
3Angiography
4Article
5Aspirin
6Cardiovascular disease
7Care and treatment
8Chronic kidney failure
9Clinical outcomes
10Clopidogrel
11Coronary Artery Disease - complications
12Coronary Artery Disease - diagnosis
13Coronary Artery Disease - mortality
14Coronary Artery Disease - therapy
15Coronary vessels
16Databases
17Diabetes
18Dosage and administration
19Drug Administration Schedule
20Drug-Eluting Stents
21Female
22Glomerular Filtration Rate
23Heart attacks
24Heart failure
25Humans
26Hypertension
27Kidney - physiopathology
28Kidney diseases
29Male
30Medicare
31Metals
32Middle Aged
33Mortality
34Multivariate Analysis
35Myocardial Infarction - etiology
36Patient outcomes
37Percutaneous Coronary Intervention - adverse effects
38Percutaneous Coronary Intervention - instrumentation
39Percutaneous Coronary Intervention - mortality
40Platelet Aggregation Inhibitors - administration & dosage
41Platelet Aggregation Inhibitors - adverse effects
42Propensity Score
43Proportional Hazards Models
44Prosthesis Design
45Renal Insufficiency, Chronic - complications
46Renal Insufficiency, Chronic - diagnosis
47Renal Insufficiency, Chronic - mortality
48Renal Insufficiency, Chronic - physiopathology
49Risk Assessment
50Risk Factors
51Sensitivity analysis
52Stents
53Studies
54Ticlopidine - administration & dosage
55Ticlopidine - adverse effects
56Ticlopidine - analogs & derivatives
57Time Factors
58Treatment Outcome
59United States
60United States Department of Veterans Affairs
61Usage
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6Ly, Samantha
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8Faxon, David P
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titleOutcomes with prolonged clopidogrel therapy after coronary stenting in patients with chronic kidney disease
authorSiddiqi, Omar K ; Smoot, Kyle J ; Dufour, Alyssa B ; Cho, Kelly ; Young, Melissa ; Gagnon, David R ; Ly, Samantha ; Temiyasathit, Sara ; Faxon, David P ; Gaziano, J Michael ; Kinlay, Scott
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1Aged
2Aged, 80 and over
3Angiography
4Article
5Aspirin
6Cardiovascular disease
7Care and treatment
8Chronic kidney failure
9Clinical outcomes
10Clopidogrel
11Coronary Artery Disease - complications
12Coronary Artery Disease - diagnosis
13Coronary Artery Disease - mortality
14Coronary Artery Disease - therapy
15Coronary vessels
16Databases
17Diabetes
18Dosage and administration
19Drug Administration Schedule
20Drug-Eluting Stents
21Female
22Glomerular Filtration Rate
23Heart attacks
24Heart failure
25Humans
26Hypertension
27Kidney - physiopathology
28Kidney diseases
29Male
30Medicare
31Metals
32Middle Aged
33Mortality
34Multivariate Analysis
35Myocardial Infarction - etiology
36Patient outcomes
37Percutaneous Coronary Intervention - adverse effects
38Percutaneous Coronary Intervention - instrumentation
39Percutaneous Coronary Intervention - mortality
40Platelet Aggregation Inhibitors - administration & dosage
41Platelet Aggregation Inhibitors - adverse effects
42Propensity Score
43Proportional Hazards Models
44Prosthesis Design
45Renal Insufficiency, Chronic - complications
46Renal Insufficiency, Chronic - diagnosis
47Renal Insufficiency, Chronic - mortality
48Renal Insufficiency, Chronic - physiopathology
49Risk Assessment
50Risk Factors
51Sensitivity analysis
52Stents
53Studies
54Ticlopidine - administration & dosage
55Ticlopidine - adverse effects
56Ticlopidine - analogs & derivatives
57Time Factors
58Treatment Outcome
59United States
60United States Department of Veterans Affairs
61Usage
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8Faxon, David P
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abstractObjectivesPatients with chronic kidney disease (CKD) are at high risk of death or myocardial infarction (MI) after percutaneous coronary interventions (PCI). We assessed whether prolonged dual antiplatelet therapy beyond the recommended 12 months may prevent adverse outcomes in patients with CKD receiving drug-eluting stents (DES) or bare-metal stents (BMS).MethodsWe studied all Veterans receiving PCI with BMS or first-generation DES in the Veterans Affairs (VA) Healthcare System between 2002 and 2006, classified by CKD (estimated glomerular filtration rate <60 mL/min) or normal renal function. We used landmark analyses from 12 months after PCI with Cox proportional hazards multivariable and propensity-adjusted models to assess the effect of prolonged clopidogrel (more than 12 months) versus 12 months or less after PCI on clinical outcomes from 1 year to 4 years after PCI.ResultsOf 23 042 eligible subjects receiving PCI, 4880 (21%) had CKD. Compared with normal renal function, patients with CKD had higher risks of death or MI 1–4 years after DES (21% vs 12%, HR=1.75; 95% CI 1.51 to 2.04) or BMS (28% vs 15%, HR=2.10; 95% CI 1.90 to 2.32). In patients with CKD receiving DES, clopidogrel use of more than 12 months after PCI was associated with lower risks of death or MI (18% vs 24%, HR=0.74; 95% CI 0.58 to 0.95), and death (15% vs 23%, HR=0.61; 95% CI 0.47 to 0.80), but had no effect on repeat revascularisation 1–4 years after PCI.ConclusionsIn patients with CKD, prolonging clopidogrel beyond 12 months after PCI may decrease the risk of death or MI only in patients receiving first-generation DES. These results support a patient-tailored approach to prolonging clopidogrel after PCI.
copEngland
pubBritish Medical Association
pmid26209334
doi10.1136/heartjnl-2014-307168
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