Impact of Clopidogrel Loading Dose in Patients With Chronic Kidney Disease Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

详细信息    查看全文

• 作者：Joon Young Kim ; MD^a ; Myung Ho Jeong ; MD ; PhD^b ; ^{myungho@chollian.net} ; Jae Hyun Moon ; MD^a ; Yong Keun Ahn ; MD ; PhD^b ; Shung Chull Chae ; MD ; PhD^c ; Seung Ho Hur ; MD ; PhD^d ; Taek Jong Hong ; MD ; PhD^e ; Young Jo Kim ; MD ; PhD^f ; In Whan Seong ; MD ; PhD^g ; In Ho Chae ; MD ; PhD^h ; Myeong Chan Cho ; MD ; PhDⁱ ; Yang Soo Jang ; MD ; PhD^j ; Jung Han Yoon ; MD ; PhD^k ; Ki Bae Seung ; MD ; PhD^l ; Seung Jung Park ; MD ; PhD^m ; Korea Acute Myocardial Infarction Registry Investigators
• 刊名：The American Journal of Cardiology
• 出版年：2012
• 出版时间：1 December, 2012
• 年：2012
• 卷：110
• 期：11
• 页码：1598-1606
• 全文大小：1182 K

文摘

The optimal loading dose of clopidogrel in patients with chronic kidney disease who undergo primary percutaneous coronary intervention for ST-segment elevation myocardial infarction has not been investigated. The aim of this study was to assess the impact of clopidogrel loading dose on clinical outcomes in this setting. A total of 1,457 patients with CKD (estimated glomerular filtration rate <60 ml/min/1.73 m²) were evaluated according to clopidogrel loading dose: 600 mg (n = 861) versus 300 mg (n = 596). In-hospital complications, including major bleeding and clinical outcomes at 1 and 12 months, were compared between the 2 groups. The in-hospital major bleeding rate was similar (0.8 % vs 0.2 % , p = 0.09). Also, there were no differences in major adverse cardiac event rates, including death, recurrent myocardial infarction, target lesion revascularization, and stent thrombosis, at 1 month (15.6 % vs 16.4 % , p = 0.70) and 12 months (19.0 % vs 21.3 % , p = 0.32). On multivariate analysis, a 600-mg loading dose of clopidogrel was not an independent predictor of 1-month (odds ratio 1.13, 95 % confidence interval 0.49 to 2.57, p = 0.78) and 12-month (odds ratio 0.89, 95 % confidence interval 0.52 to 1.51, p = 0.66) major adverse cardiac events. After propensity score-matched analysis, these results were unchanged. In conclusion, a 600-mg loading dose of clopidogrel was not effective in reducing 1- and 12-month major adverse cardiac events in patients with chronic kidney disease who underwent primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, but this dose did not increase the in-hospital major bleeding rate.