Objectives To elucidate effect of dual antiplatelet therapy on platelet response in acute myocardial infarction patients with chronic kidney disease.
Methods From September 2011 to June 2012, a total of 195 acute myocardial infarction patients undergoing drug eluting stent implanting were enrolled, among them, 133 cases with normal renal function, and 62 cases with chronic kidney disease (CKD). We examined platelet reactivity after clopidogrel 300 mg and aspirin 300 mg treatment for 24 h. High on treatment platelet reactivity (HPR) was defined as > 55% for light transmission aggreometry.
Results The CKD patients had higher diabetes mellitus (24.8% vs 43.5%, P = 0.01), anaemia (5.6% vs 16.1%, P = 0.03) and high on treatment platelet reactivity (28.6% vs 45.2%, P = 0.03) than those with normal kidney function patients. Logistic regression analyses showed that CKD and diabetes mellitus were independent predictors of HPR. Prevalence of HPR was higher in CKD patients compared with normal kidney function patients (65.1% ± 10.2 vs 45.3% ± 7.8, P < 0.01). In subgroup analysis testing was done before and after antiplatelet treatment. At baseline there were no differences in platelet aggregation, however, absolute decrease in reactivity after antiplatelet treatment was significantly less in CKD patients compared to patients with normal kidney function (63.2% ± 8.6 vs 43.2% ± 5.2, P < 0.01).
Conclusions CKD is an important contributor to apparent HPR.